Medicare | The Health Law Firm Blog

Medicare is at the center of many legal issues. Health care reform and regulation make Medicare an important topic for health care providers.

Have You Received a Notice of Termination of Your Medicare Provider Number?

Have you received a notice of termination of your Medicare provider number? Medicare has been revoking the Medicare provider numbers of many different Medicare providers including physicians, medical groups, home health agencies (HHAs), pharmacies, and durable medical equipment (DME) providers, based on returned mail sent to old addresses which have not been updated or based on inspection team site visits to old addresses.

Often the termination is retroactive to a much earlier date the change or move may have been determined to have occurred. Even if the mailing address is correct or was changed, the physical address of the business must have been updated, as well. It is usually an incorrect or old physical address which causes this […]

Excess Readmissions Mean Lower Medicare Reimbursement Rates for More than 2,000 Hospitals, Including 131 in Florida

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Lower Medicare reimbursement rates are coming in October of 2012, to 2,211 hospitals around the country, including 131 in Florida. This is allegedly due to excessive readmission rates in these hospitals between July 2008 and June 2011, according to the Centers for Medicare and Medicaid Services (CMS). This story was originally reported by Kaiser Health News on August 13, 2012, and by other sources.

Starting in October 2012, Millions of Dollars in Penalties will be Deducted from […]

By The Health Law Firm|2024-03-14T10:00:34-04:00June 1, 2018|In the Know, Medicare, The Health Law Firm Blog|

South Florida Pharmacy Owner Pleads Guilty to $23 Million Health Care Fraud Scheme

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A co-owner and operator of three Miami-area pharmacies pleaded guilty on December 6, 2012, for his part in a $23 million health care fraud scheme. The pharmacy owner allegedly admitted in the Florida Southern Federal District Court to one count of conspiracy to commit health care fraud and one count of conspiracy to pay illegal health care kickbacks, according to a Department of Justice (DOJ) press release.

Click here to read the entire press release from the DOJ.

Pharmacy Owner Used Kickbacks and Referrals to Allegedly Scam Medicare and Medicaid.

According to […]

By The Health Law Firm|2024-03-14T10:00:41-04:00June 1, 2018|Assisted Living Facilities, Medicaid, Medicare, Medicare Fraud, The Health Law Firm Blog|

CMS Fights Medicare Fraud With Ban on New Home Health Agencies and Ambulance Suppliers in Three Cities

By Lance O. Leider, J.D., The Health Law Firm and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The Centers for Medicare and Medicaid Services (CMS) announced it will temporarily ban new home health providers and ambulance suppliers from enrolling in Medicare, Medicaid and the Children’s Health Insurance Program (CHIP) in three fraud “hot spots.” According to CMS, the six-month moratorium begins July 30, 2013. It applies to newly enrolling home health agencies (HHAs) in Miami, Florida, and Chicago, Illinois. It also applies to newly enrolling ambulance suppliers in Houston, Texas. Existing providers and suppliers can continue to deliver and bill […]

By The Health Law Firm|2024-03-14T10:00:51-04:00June 1, 2018|Affordable Care Act, In the Know, In the News, Medicare, Medicare Fraud, The Health Law Firm Blog|

“Cert Audits” Newest in Medicare Audit Contractor Alphabet?

One of the newest acronyms that our law firm has encountered in the Medicare Program’s audit process is the Medicare Comprehensive Error Rate Testing program audit or CERT audit. It could be that we just haven’t had clients who had problems with this in the past, as we have seen plenty of Zone Program Integrity Contractor (ZPIC) audits, Medicare Administrative Contractor (MAC) audits and actions, Medicaid Fraud Control Unit (MFCU) audits, etc. However, we did have a client recently who was being audited by a CERT contractor and we assisted in resolving document discrepancies.

The Centers for Medicare & Medicaid Services (CMS) created the Comprehensive Error Rate Testing (CERT) program to measure the paid claims error rate for Medicare claims submitted […]

By The Health Law Firm|2024-03-14T10:00:28-04:00June 1, 2018|Medicare, The Health Law Firm Blog|

Whistleblower Lawsuit Alleges Florida Adventist Hospitals Overbilled Millions of Dollars

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A whistleblower lawsuit based on information from a former Florida Hospital Orlando billing employee and a former staff physician alleges that seven of Adventist’s Florida hospitals overbilled the federal government between 1995 and 2009, resulting in tens of millions of dollars in false or padded medical claims, according to an article in the Orlando Sentinel and other sources.

To read the entire False Claims Act complaint filed, click here.

Hospital Allegedly Used Improper Coding to Overbill Medicare, Medicaid and Tricare.

The suit claims that seven Adventist Florida hospitals […]

By The Health Law Firm|2024-03-14T10:00:35-04:00June 1, 2018|In the Know, In the News, Medicaid audit, Medicare, The Health Law Firm Blog, Whistleblower|

Tennessee-Based Nursing Care Company Being Investigated for Medicare Fraud

By Danielle M. Murray, J.D.

The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) is investigating a Tennessee-based nursing care company. The company runs more than 200 skilled nursing homes (SNFs), assisted living facilities (ALFs), retirement living communities, home care services, and Alzheimer’s centers across the country. The nursing care company is accused of defrauding Medicare of millions of dollars for unnecessary and expensive therapy treatments from 2006 to 2011, according to the Wall Street Journal.

Click here to read the entire article from the Wall Street Journal.

Therapists Allegedly Encouraged to Perform Unnecessary and Costly […]

By The Health Law Firm|2024-03-14T10:00:42-04:00June 1, 2018|Assisted Living Facilities, Home health care facility, Medicare, Medicare Audit, Medicare Fraud, The Health Law Firm Blog, Whistleblower|

Oncologist Accused of Billing Medicare for Unnecessary Chemotherapy-Employee Whistleblowers Filed First Claim

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A Michigan oncologist is accused of deliberately misdiagnosing patients with cancer so he could allegedly administer chemotherapy treatments and bill the government for those treatments, according to the Department of Justice (DOJ). For more than two years the oncologist allegedly billed Medicare for $35 million in fraudulent claims. The oncologist was charged on August 19, 2013, with one count of Medicare fraud, according to the DOJ.

On top of submitting false claims to Medicare, a criminal complaint alleges a number of other serious charges. These include hiring doctors who may not have been properly […]

By The Health Law Firm|2024-03-14T10:00:51-04:00June 1, 2018|In the News, Medicare, Medicare Fraud, The Health Law Firm Blog, Whistleblower|

ZPIC or Medicare Audit and Site Visit Checklist

As a physician, medical group or other healthcare provider, if you receive a notice of an audit and site visit from Medicare, the Medicare Administrative Carrier (MAC) or the Zone Program Integrity Contractor (ZPIC), things happen fast with little opportunity to prepare. Hopefully this checklist will help you to prepare for the on-site visit that will shortly follow.

Many items on this checklist may seem common sense to the reader; however, they would not be on here if I did not encounter them as problems in at least two different instances for each one.

Immediately check your address on the letter to ensure it is the correct and complete physical address of the site visit, including the suite number.
Immediately call […]

By The Health Law Firm|2024-03-14T10:00:29-04:00June 1, 2018|Medicare, The Health Law Firm Blog|

How to Speed Up the Medicare Prepayment Review Process

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

For Medicare providers, being notified of an impending audit is not welcome news. Being notified of a prepayment review is even worse. In a prepayment review, the health care provider must submit documentation to the Centers for Medicare & Medicaid Services (CMS) contractor before ever receiving payment. The health care provider will only receive payment (typically months later) if the contractor is satisfied with the provider’s documentation. This can be financially disastrous for the health care provider, who still must pay day-to-day expenses while waiting for a decision.

CMS Contractors.

If you […]

By The Health Law Firm|2024-03-14T10:00:35-04:00June 1, 2018|In the Know, Medicare, The Health Law Firm Blog|