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Dentists: Challenge Overpayment Demands from Medicare, Medicaid Audits!

During our years of experience, we have gotten many calls from dentists who have been placed on prepayment review after failing to challenge the results of Medicare and Medicaid audits. Once placed on prepayment review, the payments are held up for many months. Some providers are even forced out of business as a result.

Failing to challenge, follow-up on, and appeal any adverse results of Medicare and Medicaid audits can be very detrimental. An error rate above 15% will usually result in the provider being placed on prepayment review.

What Happens During Prepayment Review.

While on prepayment review, the dentist or provider will be required to submit documentation for medical records by mail to support each claim submitted. Additionally, they must have those claims and supporting documentation audited, before any […]

By The Health Law Firm|2024-03-14T10:00:09-04:00November 6, 2019|Categories: Dental Law Blog|Tags: allegations of healthcare fraud, allegations of overbilling Medicaid, attorney legal representation for OIG notice of intent to exclude, Centers for Medicare and Medicaid (CMS), False Claims attorney, FCA attorney, FCA defense lawyer, FCA lawyer, health care fraud defense attorney, health care professional defense attorney, healthcare fraud defense lawyer, healthcare fraud representation, legal representation for CMS investigations, legal representation for fraud investigations, legal representation for health care fraud, legal representation for health care professionals, legal representation for Medicare and Medicaid audits, medical overbilling, Medicare administrative law judge hearing defense attorney, Medicare administrative law judge hearing legal representation, Medicare and Medicaid audit defense attorney, Medicare audit defense attorney, Medicare audit defense legal counsel, Medicare exclusion hearing defense attorney, Office of Inspector General (OIG) Medicare exclusion attorney, Office of Inspector General (OIG) Medicare exclusion defense counsel, Office of Inspector General (OIG) Medicare exclusion legal defense counsel, OIG exclusion defense attorney, OIG exclusion defense lawyer, OIG investigation legal defense representation, representation for CMS investigations, representation for healthcare investigations, representation for medical overbilling, representation for overbilling Medicare, representation for submitting false claims, reviews for The Health Law Firm, The Health Law Firm attorney reviews|Comments Off

CMS Announces Final Rule to Reduce Criminal Behavior in Medicare, Medicaid

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

On September 5, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that strengthens the ability to stop fraud and abuse before it happens. The “Program Integrity Enhancements to the Provider Enrollment Process” goes into effect on November 4, 2019, and will help keep untrustworthy providers out of federal health insurance. The new affiliations provision will allow CMS to identify individuals and organizations that pose an undue risk of fraud, waste or abuse and repeat offenders.

Details on the Rule.

The final rule, (CMS-6058-FC), creates several new revocation and denial authorities to enhance CMS’ efforts to stop fraud and abuse.

Similar to the affiliations component, these authorities provide a basis for administrative action to revoke or deny, as applicable, Medicare enrollment if:

[…]

Follow These Steps to Challenge OIG Exclusion From Medicare

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

Many health professionals don’t understand the significant repercussions that an exclusion action by the Office of the Inspector General (OIG) can have on their professional careers and future employment. Whether you are a physician, nurse, dentist, psychologist or other health professionals, if you allow yourself to be excluded from the Medicare program, devastating economic results may follow.

The administrative process by which you may challenge a proposal from the OIG for most permissive or mandatory exclusion is challenging. In most cases, you will need experienced legal representation. Below are the steps in the process you must follow to protect your career and your livelihood.

How to Challenge OIG Exclusion Actions.

1. Notice of Intent (NOI) received: If the OIG […]

By The Health Law Firm|2024-03-14T10:00:11-04:00August 28, 2019|Categories: Nursing Law Blog|Tags: allegations of healthcare fraud, attorney legal representation for OIG notice of intent to exclude, Centers for Medicare and Medicaid (CMS), False Claims attorney, FCA attorney, FCA lawyer, health care fraud defense attorney, health care professional defense attorney, healthcare fraud representation, legal representation for CMS investigations, legal representation for fraud investigations, legal representation for health care fraud, legal representation for health care professionals, legal representation for Medicare and Medicaid audits, Medicare administrative law judge hearing defense attorney, Medicare administrative law judge hearing legal representation, Medicare and Medicaid audit defense attorney, Medicare audit defense attorney, Medicare audit defense legal counsel, Medicare exclusion hearing defense attorney, Office of Inspector General (OIG) Medicare exclusion attorney, Office of Inspector General (OIG) Medicare exclusion defense counsel, Office of Inspector General (OIG) Medicare exclusion legal defense counsel, OIG exclusion defense attorney, OIG exclusion defense lawyer, OIG investigation legal defense representation, representation for CMS investigations, representation for healthcare investigations, representation for medical overbilling, representation for submitting false claims, reviews for The Health Law Firm, The Health Law Firm attorney reviews|Comments Off

The Administrative Process to Challenge OIG Exclusion Actions

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

Many health professionals don’t understand the significant repercussions that an exclusion action by the Office of the Inspector General (OIG) can have on their professional careers and future employment. Whether you are a physician, nurse, dentist, psychologist or other health professionals, if you allow yourself to be excluded from the Medicare program, devastating economic results may follow.

The administrative process by which you may challenge a proposal from the OIG for most permissive or mandatory exclusion is challenging. In most cases, you will need experienced legal representation. Below are the steps in the process you must follow to protect your career and your livelihood.

How to Challenge OIG Exclusion Actions.

1. Notice of Intent (NOI) received: If the OIG is proposing to exclude a person or entity from […]

By The Health Law Firm|2024-03-14T10:00:11-04:00August 14, 2019|Categories: Mental Health Law Blog|Tags: allegations of healthcare fraud, attorney legal representation for OIG notice of intent to exclude, Centers for Medicare and Medicaid (CMS), False Claims attorney, FCA attorney, FCA lawyer, health care fraud defense attorney, health care professional defense attorney, healthcare fraud representation, legal representation for CMS investigations, legal representation for fraud investigations, legal representation for health care fraud, legal representation for health care professionals, legal representation for Medicare and Medicaid audits, Medicare administrative law judge hearing defense attorney, Medicare administrative law judge hearing legal representation, Medicare and Medicaid audit defense attorney, Medicare audit defense attorney, Medicare audit defense legal counsel, Medicare exclusion hearing defense attorney, Office of Inspector General (OIG) Medicare exclusion attorney, Office of Inspector General (OIG) Medicare exclusion defense counsel, Office of Inspector General (OIG) Medicare exclusion legal defense counsel, OIG exclusion defense attorney, OIG exclusion defense lawyer, OIG investigation legal defense representation, representation for CMS investigations, representation for healthcare investigations, representation for medical overbilling, representation for submitting false claims, reviews for The Health Law Firm, The Health Law Firm attorney reviews|Comments Off

Steps to Challenge OIG Exclusion Action from Medicare Program

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

Many health professionals don’t understand the significant repercussions that an exclusion action by the Office of the Inspector General (OIG) can have on their professional careers and future employment. Whether you are a physician, nurse, dentist, psychologist or other health professionals, if you allow yourself to be excluded from the Medicare program, devastating economic results may follow.

The administrative process by which you may challenge a proposal from the OIG for most permissive or mandatory exclusion is challenging. In most cases, you will need experienced legal representation. Below are the steps in the process you must follow to protect your career and your livelihood.

The Administrative Process to Challenge OIG Exclusion Actions.

1. Notice of Intent (NOI) received: If the OIG is proposing to exclude a person […]

By The Health Law Firm|2024-03-14T10:00:12-04:00July 30, 2019|Categories: Health Facilities Law Blog|Tags: allegations of healthcare fraud, attorney legal representation for OIG notice of intent to exclude, Centers for Medicare and Medicaid (CMS), False Claims attorney, FCA attorney, FCA lawyer, health care fraud defense attorney, health care professional defense attorney, healthcare fraud representation, legal representation for CMS investigations, legal representation for fraud investigations, legal representation for health care fraud, legal representation for health care professionals, legal representation for Medicare and Medicaid audits, Medicare administrative law judge hearing defense attorney, Medicare administrative law judge hearing legal representation, Medicare and Medicaid audit defense attorney, Medicare audit defense attorney, Medicare audit defense legal counsel, Medicare exclusion hearing defense attorney, Office of Inspector General (OIG) Medicare exclusion attorney, Office of Inspector General (OIG) Medicare exclusion defense counsel, Office of Inspector General (OIG) Medicare exclusion legal defense counsel, OIG exclusion defense attorney, OIG exclusion defense lawyer, OIG investigation legal defense representation, representation for CMS investigations, representation for healthcare investigations, representation for medical overbilling, representation for submitting false claims, reviews for The Health Law Firm, The Health Law Firm attorney reviews|1 Comment

How to Challenge an OIG Exclusion Action from Medicare

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

Many health professionals don’t understand the significant repercussions that an exclusion action by the Office of the Inspector General (OIG) can have on their professional careers and future employment. Whether you are a physician, nurse, dentist, psychologist or other health professionals, if you allow yourself to be excluded from the Medicare program, devastating economic results may follow.

The administrative process by which you may challenge a proposal from the OIG for most permissive or mandatory exclusion is challenging. In most cases, you will need experienced legal representation. Below are the steps in the process you must follow to protect your career and your livelihood.

The Administrative Process to Challenge OIG Exclusion Actions.

1. Notice of Intent (NOI) received: If the OIG is proposing to exclude a person or entity […]

By The Health Law Firm|2024-03-14T10:00:13-04:00July 9, 2019|Categories: Pharmacy Law Blog, Uncategorized|Tags: allegations of healthcare fraud, attorney legal representation for OIG notice of intent to exclude, Centers for Medicare and Medicaid (CMS), False Claims attorney, FCA attorney, FCA lawyer, health care fraud defense attorney, health care professional defense attorney, healthcare fraud representation, legal representation for CMS investigations, legal representation for fraud investigations, legal representation for health care fraud, legal representation for health care professionals, legal representation for Medicare and Medicaid audits, Medicare administrative law judge hearing defense attorney, Medicare administrative law judge hearing legal representation, Medicare and Medicaid audit defense attorney, Medicare audit defense attorney, Medicare audit defense legal counsel, Medicare exclusion hearing defense attorney, Office of Inspector General (OIG) Medicare exclusion attorney, Office of Inspector General (OIG) Medicare exclusion defense counsel, Office of Inspector General (OIG) Medicare exclusion legal defense counsel, OIG exclusion defense attorney, OIG exclusion defense lawyer, OIG investigation legal defense representation, representation for CMS investigations, representation for healthcare investigations, representation for medical overbilling, representation for submitting false claims, reviews for The Health Law Firm, The Health Law Firm attorney reviews|Comments Off

So, the ZPIC Medicare Auditor Wants to Talk to You? What You Should Expect

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

You are a physician, nurse or other health care provider who bills Medicare. You have received that dreaded letter from the Zone Program Integrity Contractor (ZPIC) for Medicare advising you that it is auditing you for the Centers for Medicare and Medicaid Services (CMS). You know that the words “Program Integrity” by themselves mean that possible fraud is being investigated, at least that is the suspicion giving rise to this particular audit.

To read an earlier blog which I wrote on tips for responding to ZPIC audits, click here.

You have dutifully contacted an experienced health law attorney to aid you in responding to the ZPIC’ s request for records […]

Walgreens Agrees to Pay $269 Million to Settle Two FCA Suits

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

On January 22, 2019, Walgreens agreed to pay more than $269 million to settle allegations of False Claims Act (FCA) violations for overbilling of various drugs. The deals are some of the largest pay-outs ever by a retail pharmacy, according to the United States Department of Justice (DOJ).

The Two Settlements.

There were two separate complaints involving Walgreens to settle federal and state lawsuits that accused the pharmacy of overbilling federal healthcare programs. Both were unsealed by U.S. District Court judges in Manhattan, according to the DOJ.

In the first settlement, Walgreens agreed to pay $209.2 million to the U.S. and several state governments for improperly billing Medicare, Medicaid and other federal healthcare programs. The pharmacy […]

DOJ Announces $2.8 Billion Recovered Funds From Healthcare Cases in 2018

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

On December 21, 2018, the U.S. Department of Justice (DOJ) announced that it recovered more than $2.8 billion from False Claims Act (FCA) (also known as “qui tam” or “whistleblower cases”) cases in 2018. Of the $2.8 billion in settlements and judgments that the government obtained during the year through FCA cases, more than $2.5 billion involved health care fraud. These cases included drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories, and physicians.

Health Care Fraud.

The DOJ’s largest recoveries involving the health care industry in 2018 came from the drug and medical device industry. In one example, AmerisourceBergen Corporation paid a whopping $625 million to settle charges filed under the whistleblower provisions of the FCA. The charges alleged that it illegally distributed […]

DOJ Announces $2.8 Billion Recovered From Healthcare FCA Cases in 2018

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

On December 21, 2018, the U.S. Department of Justice (DOJ) announced that it recovered more than $2.8 billion from False Claims Act (FCA) (also known as “qui tam” or “whistleblower cases”) cases in 2018. Of the $2.8 billion in settlements and judgments that the government obtained during the year through FCA cases, more than $2.5 billion involved health care fraud. These cases included drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories, and physicians.

Health Care Fraud.

The DOJ’s largest recoveries involving the health care industry in 2018 came from the drug and medical device industry. In one example, AmerisourceBergen Corporation paid a whopping $625 million to settle charges filed under the whistleblower provisions of the FCA. The charges alleged that it illegally distributed […]