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OIG Report Shows Physicians Fail to Appeal Payment Denials 99% of the Time

An extraordinary recent Office of Inspector General (OIG) report provides objective evidence that physician groups are owed billions. As Provider advocates, Frier Levitt challenges improper claim denials by Medicare Advantage Organizations (MAOs) in Medicare Advantage (MA) capitated plans. Frier Levitt has consistently written about how MAOs deny preauthorization and claims for payment in order to increase profits, all at the expense of beneficiaries and providers. Skeptics would say our pro-provider...

Frier Levitt Successfully Defends Physician Before the Board of Medical Examiners Regarding Fraudulent Billing

Recently, Frier Levitt defended a physician before the Board of Medical Examiners facing patient allegations of fraudulent billing. Frier Levitt submitted the formal documents explaining the patient care provided by the physician and the patient's fundamental misunderstanding of the complex nature of medical billing practices. After reviewing Frier Levitt's submission, the Board closed the case without filing a disciplinary action and ensured the matter would remain strictly confidential. If you...

Healthcare Organizations and Entity Types: What You Need to Know About Benefit Corporations

When deciding on an entity type for a healthcare organization, including physician practices and specialty groups like oncology practices, many different aspects of the organization should be taken into consideration, including funding, taxability, profit distribution to owners, social objective/non-profit mission, and limitation on activities, among others. One option, incorporating as a benefit corporation, may legally protect an organization's goals by creating accountability towards the organization's social and environmental commitments. Benefit...

503A Compounding Alert: FDA Issues a Newly Revised Draft MOU

Earlier this year, the U.S. Food and Drug Administration (FDA) released its 2018 Compounding Policy Priorities Plan, aimed at providing an overview of the key priorities the FDA sought to pursue in its continued implementation of the federal law surrounding compounding. One of the FDA’s action items in the Compounding Priorities Plan was to revise the Memorandum of Understanding (MOU) policy that was initially drafted by the FDA in 1999...

New Medicare Shared Savings Program Proposed Rule for Accountable Care Organizations

The Centers for Medicare & Medicaid Services (CMS) recently issued a proposed rule, which would institute a number of major changes to the Medicare Shared Savings Program (MSSP) for Accountable Care Organizations (ACOs). The proposed rule, which creates a redesigned program titled "Pathways to Success," changes the overall structure of the MSSP, and requires ACOs to assume more risk than they are required to under the current MSSP. Under the...