representation for medical overbilling | The Health Law Firm Blog

Medicare Final Rule Decreased Physician Payments But Expands Coverage to Counselors

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

On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that decreased overall payment rates for services provided under the Physician Fee Schedule (PFS). However, the final rule increased payment rates for outpatient services and expanded telehealth services. The rule went into effect January 1, 2024.

Physician Fee Schedule Rate Reductions; Counselors Added.

The overall payment rates under the 2024 PFS were reduced by 1.25 percent for 2024. The conversion factor is $32.74, which is a $1.15 decrease from 2023. Physicians’ Medicare reimbursements […]

By The Health Law Firm|2024-03-14T09:59:08-04:00April 15, 2024|Pharmacy Law Blog|

Medicare Final Rule Decreased Physician Payments But Expands Coverage to Counselors

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

On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that decreased overall payment rates for services provided under the Physician Fee Schedule (PFS). However, the final rule increased payment rates for outpatient services and expanded telehealth services. The rule went into effect January 1, 2024.

Physician Fee Schedule Rate Reductions; Counselors Added.

The overall payment rates under the 2024 PFS were reduced by 1.25 percent for 2024. The conversion factor is $32.74, which is a […]

Medicare Final Rule Decreased Physician Payments But Expands Coverage to Counselors

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

On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that decreased overall payment rates for services provided under the Physician Fee Schedule (PFS). However, the final rule increased payment rates for outpatient services and expanded telehealth services. The rule went into effect January 1, 2024.

Physician Fee Schedule Rate Reductions; Counselors Added.

The overall payment rates under the 2024 PFS were reduced by 1.25 percent for 2024. The conversion factor is $32.74, which is a […]

By The Health Law Firm|2024-03-14T09:59:10-04:00March 4, 2024|Mental Health Law Blog, The Health Law Firm Blog|

Court Assesses $170 Million in Fines Against Two Texas Ophthalmologists For False Claims

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

On November 18, 2021, the Justice Department announced that two Texas ophthalmologists and their eye clinic must pay millions of dollars in penalties for fraudulently billing Medicare. The penalties were assessed in connection with their evaluation and treatment of glaucoma.

U.S. District Judge Lynn Hughes assessed $170 million in penalties against the ophthalmologists and their eye clinic in Houston, Outreach Diagnostic Clinic.

A Former Employee Blew the Whistle.

According to the U.S. Department of Justice (DOJ), the action resulted from a False Claims Act (FCA) or “qui tam” suit. The whistleblower was […]

By The Health Law Firm|2024-03-14T09:59:30-04:00May 12, 2023|Health Facilities Law Blog, In the News|

Former Dental Office Manager Sentenced to One Year in Prison for Defrauding Medicaid Out of More Than $813,000

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

On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. The office manager for Universal Smiles, a D.C.-based dental practice was sentenced for her guilt in bilking Medicaid, according to the U.S. attorney’s office for D.C.

The office manager was indicted in January 2019, along with the dentist who ran the practice. The office manager pleaded guilty in May 2021 in the U.S. District Court for the District of Columbia and admitted she received over $813,000 through false billings.

The Fraudulent Billing […]

By The Health Law Firm|2024-03-14T09:59:30-04:00May 12, 2023|Dental Law Blog|

How Can I Be Sure I Don’t Have Employees, Contractors Who Are on Medicare’s Exclusion List?

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
We are often consulted by companies in the health care industry and by health professionals after they receive a subpoena or audit regarding their employing or contracting with an individual or business that is on the Office of the Inspector General’s (OIG’s) List of Excluded Individuals and Entities (LEIE), who are prohibited from contracting with Medicare. This can cause devastating consequences since the law prohibits this by anyone contracting with the government or receiving any payments from any government healthcare program from dealing with […]

By The Health Law Firm|2024-03-14T10:00:03-04:00March 13, 2020|Health Facilities Law Blog|

Mental Health Professionals: You Must Challenge Overpayment Demands from Medicare and Medicaid Audits

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
We have gotten calls from many mental health professionals who have been placed on prepayment review after failing to challenge Medicare or Medicaid audit results. 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 audit results 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, […]

By The Health Law Firm|2024-03-14T10:00:07-04:00December 5, 2019|Mental Health Law Blog|

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 […]

By The Health Law Firm|2024-03-14T10:00:09-04:00November 6, 2019|Dental Law Blog|

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 […]

By The Health Law Firm|2024-03-14T10:00:10-04:00September 24, 2019|The Health Law Firm Blog, Uncategorized|

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. […]

By The Health Law Firm|2024-03-14T10:00:11-04:00August 28, 2019|Nursing Law Blog|