audit defense attorney | The Health Law Firm Blog

Tips for Responding to a Medicaid Audit

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

Should you find yourself, your facility or your health practice the subject of a Medicaid audit by your state Medicaid agency or audit contractor, there are a few things you should know.

The most important thing is that just because you are being audited, it does not mean that you or your business has done anything wrong. State and federal governments conduct audits for many different reasons. Typical reasons include: special audits of high-fraud geographic areas, auditing of particular billing codes, randomly selected provider auditing, and complaints of possible fraud.

Medicaid Audits in Florida.

The Agency for […]

By The Health Law Firm|2024-03-14T10:00:46-04:00June 1, 2018|Medicaid, Medicaid audit, The Health Law Firm Blog|

Centers for Medicare and Medicaid Services Puts Recovery Audit Contractor Program on Hold

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

On February 18, 2014, the Centers for Medicare and Medicaid Services (CMS) announced it is in the procurement process for the next round of Recovery Audit Program contracts. This means the program is, for the time being, on hold while CMS awards new contracts. According to CMS, it will select new vendors to continue the Recovery Audit Contractor (RAC) program, which is responsible for detecting improper Medicare payments. It is expected that this pause will also be used to refine and improve the RAC program. In the announcement it was not disclosed how long […]

By The Health Law Firm|2024-03-14T10:00:55-04:00June 1, 2018|In the Know, Medicare, Medicare Audit, The Health Law Firm Blog|

The RACs, They’re Back! The Return of Medicare Recovery Audits

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

All good things must come to an end. This includes the two-month hiatus from Recovery Audit Contractors (RACs) that healthcare professionals enjoyed. The Centers for Medicare and Medicaid Services (CMS) is restarting audits of Medicare fee-for-service claims on a limited basis. The program has been suspended since June 1, 2014, due to expired contracts.

CMS announced the return of RACs on August 4, 2014.

Click here to read the latest announcements on Medicare recovery audits from CMS.

From what we have heard, there were serious problems with some of the audits that had […]

By The Health Law Firm|2024-03-14T10:00:57-04:00June 1, 2018|Centers for Medicare and Medicaid Services, Medicare, Medicare Audit, The Health Law Firm Blog|

CMS Recovery Audit Prepayment Reviews to Begin Summer 2012

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

The Centers for Medicare & Medicaid Services (CMS) is planning to start the Recovery Audit Prepayment Review (RAPR) Demonstration Project on June 1, 2012. It was originally scheduled to begin January 1, 2012.

Recovery Audit Contractors (RACs) to Review Claims with High Rates of Improper Billing.

The Recovery Audit Prepayment Review allows Recovery Audit Contractors (RACs) to review claims before they are paid. The goal is to ensure that the provider complied with all Medicare payment rules. Prepayment reviews will be conducted on certain types of claims that have been found to result in […]

By The Health Law Firm|2024-03-14T10:00:31-04:00June 1, 2018|Medicare, The Health Law Firm Blog|

Be Prepared for a Medicaid Audit Request

By Lance O. Leider, J.D., M.P.A., LL.M., Board Certified by the Florida Bar in Health Law

Florida healthcare providers servicing Medicaid patients are at a higher risk for audits than anywhere else in the country. The reason is that Florida has become synonymous with healthcare fraud. As a result, auditing and subsequent overpayment demands are some very real possibilities.

Should you find yourself, your facility, or your health practice the subject of a Medicaid audit by your state Medicaid agency or audit contractor, there are a few things you should know.

The most important thing is that just because you are being audited, it does not mean that […]

By The Health Law Firm|2024-03-14T10:00:33-04:00June 1, 2018|Medicaid, Medicaid audit, The Health Law Firm Blog|

August 27, 2012, Marks the Start Date of the CMS Recovery Audit Prepayment Review (RAPR)

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

On July 31, 2012, the Centers for Medicare and Medicaid Services (CMS) announced on its website that hospitals should brace themselves for prepayment audits beginning August 27, 2012.

The CMS originally announced the Recovery Audit Prepayment Review (RAPR) Demonstration Project in November of 2011 for a January 1, 2012 start date, then delayed it to June 1, 2012, then again to, “summer of 2012.”

To see the official announcement from the CMS, click here.

Recovery Audit Contractors (RACs) will Review Claims with High Rates of Improper Billing.

[…]

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

U.S Department of Justice (DOJ) Investigating the Cardiology Services at Florida Hospitals

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On Monday, August 6, 2012, a New York Times article revealed that cardiology services at some Florida HCA hospitals are under investigation by the U.S. Department of Justice (DOJ) for allegedly performing unnecessary procedures to increase profits.

Click here to see the entire New York Times article posted August 6, 2012.

I previously blogged about and published an article on how a number of medical specialty societies have released lists of unnecessary or ineffective procedures.

To read that article, originally published in […]

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

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|

What You Need to Know About Preparing and Responding to an Initial Medicaid Audit Request

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

Health care providers in Florida who service Medicaid patients are at a higher risk for audits than anywhere else in the country. The unfortunate truth is that Florida has become synonymous with health care fraud. As a result, auditing and subsequent overpayment demands are very real possibilities.

The Health Law Firm and its legal professionals represent health care providers in virtually every aspect of Medicaid program audits, investigations and litigation. These include physicians, medical groups, mental health professionals, pharmacies, nursing homes, home health agencies, hospitals and other […]

By The Health Law Firm|2024-03-14T10:01:52-04:00May 15, 2018|Mental Health Law Blog|

What You Need to Know About Preparing and Responding to an Initial Medicaid Audit Request

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

Health care providers in Florida who service Medicaid patients are at a higher risk for audits than anywhere else in the country. The unfortunate truth is that Florida has become synonymous with health care fraud. As a result, auditing and subsequent overpayment demands are very real possibilities.

The Health Law Firm and its legal professionals represent health care providers in virtually every aspect of Medicaid program audits, investigations and litigation. These include physicians, medical groups, mental health professionals, pharmacies, nursing homes, home health agencies, hospitals and other health facilities.

Facts You Should Know About the Medicaid Audit […]

By The Health Law Firm|2024-03-14T10:01:20-04:00May 15, 2018|Dental Law Blog|