News & Analysis as of

Audits Healthcare Overpayment

Nelson Mullins Riley & Scarborough LLP

Understanding the Medicare Overpayment Appeals Process

Every Medicare provider should understand the Medicare administrative appeals process. Providers are entitled to be reimbursed for their services and want to keep those reimbursements safe from audits. However, if Medicare...more

Baker Donelson

OIG Hospital Compliance Audits: Is Your Number Up? Are You Ready?

Baker Donelson on

In its Work Plan for Fiscal Year 2012, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) announced it would begin reviews of Medicare payments to hospitals to determine compliance...more

Foley & Lardner LLP

CMS's Focus on DMEPOS Fraud and Abuse Risks Continues

Foley & Lardner LLP on

The focus by the Centers for Medicare & Medicaid Services (CMS) on Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) as an area rife with unnecessary utilization and a high improper payment rates...more

King & Spalding

Health Headlines: Also in the News - May 2014

King & Spalding on

OIG Reports Jurisdiction H Contractors Made $3.3 Million in Overpayments for Outpatient Drugs – According to a recent OIG report, the Medicare Contractors for Jurisdiction H overpaid providers approximately $3.3...more

King & Spalding

Third Circuit Holds Judicial Review of Extrapolated Overpayment Determinations is Precluded

King & Spalding on

On February 12, 2014, the U.S. Court of Appeals for the Third Circuit held that Federal courts do not have jurisdiction to review HHS’s determination of a “sustained or high level of payment error,” one of two possible...more

Williams Mullen

Extrapolated Medicaid Audits Continue: Be Proactive! (Or Move to West Virginia)

Williams Mullen on

Extrapolated audits are no fun, unless you work for a recovery audit contractor (RAC). You get a Tentative Notice of Overpayment (TNO) that says the auditor reviewed 100 dates of service (DOS), found an overpayment of...more

Baker Donelson

Self-Audit Results Found Sufficient to Sustain False Claims Act Complaint

Baker Donelson on

District Court Finds That Medical Group’s Failure to Further Investigate Audit Results May Violate Requirement to Return Overpayments - Background - Internal audits of third-party payment claims – frequently...more

The Volkov Law Group

Hospitals: Audits And Compliance

The Volkov Law Group on

Hospitals are under intense scrutiny. The federal government knows that one sure way to reduce healthcare costs is to get hospitals to lower their costs. Hospitals feel the pinch given the need to generate revenue but know...more

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