Thomas Hess

Thomas Hess

Dinsmore & Shohl LLP

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Big Changes to Administrative Law Hearings for Medicare Providers

Effective October 27, 2014, the Medicare Program Integrity Manual (“Manual”) will require Medicare Administrative Contractors (“MACs”) to participate in administrative hearings concerning medical review decisions. ...more

10/22/2014 - Administrative Hearings CMS Healthcare Medicare

Health Care Providers: Five Actions to Help You Avoid Qui Tam Lawsuits

2013 proved to be another record-setting year for False Claims Act lawsuits, the largest of these recoveries related to health care fraud. The Department of Justice (“DOJ”) secured $3.8 billion from False Claims Act...more

9/2/2014 - Best Management Practices DOJ False Claims Act Health Care Providers Healthcare

OIG: Medicare Inappropriately Paid for 2010 E/M Services Claims - Physicians should expect higher scrutiny on Medicare claims...

Inspector General Daniel R. Levinson with the Office of the Inspector General (“OIG”) recently issued a startling report explaining that Medicare inappropriately paid $6.7 billion for claims for E/M Services in 2010. These...more

6/20/2014 - Evaluation and Management Services Healthcare Medicare OIG Overpayment Physician Medicare Reimbursements Physicians

Update: Federal Government Aggressively Pursuing Health Care Fraud

The July 2013 alert, Federal Government Aggressively Pursuing Health Care Fraud, stressed the importance of self-audits for health care providers. With the Obama administration taking a hard-line approach to repeat offenders...more

2/28/2014 - Enforcement Enforcement Actions Healthcare Healthcare Fraud

OIG Exclusion List: What it Means, What You Should Do

On January 8, 2014, the Office of Inspector General (“OIG”) updated the List of Excluded Individuals and Entities (“LEIE”). According to the LEIE, over 66,000 health care providers are currently excluded from all Federal...more

1/15/2014 - Exclusions Healthcare Healthcare Fraud Healthcare Reform LEIE Medicaid Medicare OIG

Federal Government Aggressively Pursuing Health Care Fraud

Proactive self-audits help providers identify potential problems - The Federal Government is using every tool available to fight health care fraud and recover overpayments from health care providers. According to the...more

7/5/2013 - Audits DOJ Enforcement Enforcement Actions Fraud Fraud and Abuse Health Insurance Healthcare Fraud Healthcare Professionals HHS Medicaid Medicare OIG

CMS Clarifies Physician Delegation of Tasks in SNFs and NFs

The Centers for Medicare and Medicaid Services (“CMS”) released an important instruction for physicians, non-physician practitioners (“NPPs”) and providers who bill for services provided in skilled nursing facilities (SNFs)...more

4/26/2013 - Billing CMS Healthcare Healthcare Professionals NFs Physicians SNF

Resubmission of Hospital Claims

On February 13, CGS Administrators, the Parts A and B Medicare Administrative Contractor for Kentucky and Ohio, relayed instructions to Medicare hospitals paid under the Inpatient Prospective Payment System from the Centers...more

3/13/2013 - Appeals CMS Hospitals Medicare Patient Prospective Payment System

2013 Brings Significant Criminal Background Check Changes for Ohio HHAs

The Ohio Department of Health has proposed new administrative rules scheduled to take effect January 1, 2013 that will significantly impact the obligations of a home health agency (“HHA”) regarding background checks of its...more

12/19/2012 - Background Checks Criminal Background Checks Hiring & Firing Home Health Agencies

Telemedicine: Physicians Need to Know State Requirements

As telemedicine grows in popularity, it is important for physicians to be aware of the state-by-state requirements when practicing in this revolutionary area of healthcare....more

12/13/2012 - Healthcare Licenses Physicians Telemedicine

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