Recognizing the ongoing impact of the cyberattack experienced by Change Healthcare/Optum on February 21, 2024, the Centers for Medicare & Medicaid Services (CMS) announced over the weekend that it will allow Part A providers...more
As addressed in the first installment of this three-part series, healthcare providers face potential audits from an increasing number of Medicare and Medicaid contractors. Failing to respond properly can lead to significant...more
Because Medicare and Medicaid claims audit requests can look like routine billing-related correspondence, they can be easy to miss, leading to expensive and potentially catastrophic consequences. Providers, therefore, should...more
Ensuring compliance with the False Claims Act has never been more important for healthcare providers. By March 2020, we saw healthcare professionals standing at the forefront of one of the greatest health crises in a...more
2/4/2021
/ Annual Reports ,
Anti-Kickback Statute ,
CARES Act ,
Coronavirus/COVID-19 ,
Criminal Investigations ,
Criminal Prosecution ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare Facilities ,
Healthcare Fraud ,
Long Term Care Facilities ,
Medical Devices ,
Medicare ,
Medicare Advantage Organizations (MAOs) ,
Nurses ,
Nursing Homes ,
OIG ,
Opioid ,
Pharmaceutical Industry ,
Pharmacist ,
Physicians ,
Qui Tam ,
Settlement Agreements ,
Stark Law ,
Telemedicine
The Medicare Physician Fee Schedule Final Rule for Calendar Year 2021 (the Final Rule) issued by the Centers for Medicare & Medicaid Services (CMS) on December 1, 2020, and published in the Federal Register on December 28,...more
1/5/2021
/ Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Drug Treatment ,
Final Rules ,
Health Care Providers ,
Medical Coding ,
Medicare ,
Opioid ,
Physician Fee Schedule ,
Physicians ,
Public Health Emergency ,
Reporting Requirements ,
Scope of Treatment ,
Telehealth ,
Vaccinations ,
Verification Requirements
In a bipartisan effort to combat the opioid crisis, H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (the Act), was enacted on October 24,...more
11/16/2018
/ Controlled Substances ,
Data-Sharing ,
Department of Health and Human Services (HHS) ,
Drug & Alcohol Abuse ,
Federal Trade Commission (FTC) ,
Health Care Providers ,
Healthcare Fraud ,
Kickbacks ,
Medicaid ,
Medicaid Expansion ,
Medicare ,
Opioid ,
Pain Management ,
Pharmaceutical Industry ,
Physicians ,
Prescription Drugs ,
Public Health ,
Substance Abuse ,
Telehealth ,
Telemedicine ,
Unfair or Deceptive Trade Practices
Recent opinions by the Fifth Circuit, the Northern and Southern Districts of Texas, and the District of South Carolina offer hope to providers seeking relief from substantial monetary recoupments during the Medicare appeals...more
9/28/2018
/ Administrative Appeals ,
Administrative Law Judge (ALJ) ,
Administrative Remedies ,
Audits ,
Centers for Medicare & Medicaid Services (CMS) ,
Complaint Procedures ,
Health Care Providers ,
Injunctive Relief ,
Irreparable Harm ,
Medicare ,
Medicare Claims Appeals Process ,
Motion for Reconsideration ,
OMHA ,
Overpayment ,
Physician Medicare Reimbursements ,
Recoupment ,
Redeterminations ,
TRO
In January 2018, Centers for Medicare & Medicaid Services (CMS) announced additional information regarding a new Low Volume Appeals (LVA) settlement option and an expanded Settlement Conference Facilitation (SCF) as part of...more
4/13/2018
/ Administrative Law Judge (ALJ) ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Low Volume Appeals Settlement Options (LVA) ,
MACs ,
Medicare ,
Medicare Appeals Council ,
Medicare Claims Appeals Process ,
Medicare Part A ,
Medicare Part B ,
OMHA