Fraud is a persistent issue in the history of U.S. healthcare. However, with the government’s decreased oversight and the implementation of telehealth billing codes and diagnostic abilities during the COVID-19 pandemic, new opportunities for... Read More
Administrative and Insurance Defense Law | Articles | Healthcare Practice Compliance | Medicare and Insurance Audits | News | Professional Practice Representation

Frier Levitt Partner Guillermo Beades and Jim Tudor, Director of Coding & Billing Compliance at HealthCare Compliance Network, recently had the opportunity to contribute their insights and expertise on medical payer audits to the American Health... Read More
Articles | Medical Practice Representation | Medicare and Insurance Audits

Frier Levitt Partner Guillermo J. Beades was quoted in a Part B News article, “Be Careful About Upcoding; DOJ May Come After it as a False Claim” by Roy Edroso. “It’s very rare for audits to be converted to civil or criminal actions,”... Read More
Administrative and Insurance Defense Law | Articles | Federal and State Fraud and Abuse Counseling | Federal and State Fraud and Abuse Counseling | Healthcare Practice Compliance | Medicare and Insurance Audits | News | Payor Network Access and Defense of Network Terminations | White Collar Criminal Defense & Government Investigations | White Collar Defense and Government Investigation

On February 9, 2023, the Centers for Medicare and Medicaid Services (“CMS”) released a memorandum (the “Memorandum”) setting forth CMS’s proposed methods for calculating so-called “Inflation Rebates” as mandated by the recent Inflation... Read More
Articles | Manufacturers | Medicare and Insurance Audits | Medicare Audit Appeals | Pharmaceutical Manufacturers | Pharmaceutical Wholesalers | Professional Practice Representation

A motion to dismiss that has been pending since last year was recently decided in the matter of U.S. ex rel. Teresa Ross v. Independent Health Association, et al. The decision may very well be a bellwether for future Medicare Advantage (“MA”)... Read More
Articles | Behavioral Health Practitioners | Dental Practices | Dispensing Physician Practices and Dispensing Physicians | Federal and State Fraud and Abuse Counseling | Healthcare Practice Compliance | Hospitals and Healthcare Systems | Managed Care Negotiations and Strategies | Medical Practice Representation | Medicare and Insurance Audits | Physicians and Medical Practices of all Specialties | Professional Practice Representation | White Collar Defense and Government Investigation

A staple of Medicare and False Claims Act (“FCA”) law – the so-called “Overpayment Rule” – may soon be undergoing a dramatic shift, and doing so in a way that could increase liability for healthcare providers while potentially reducing... Read More
All types of single and multi-specialty medical practice groups | Articles | Behavioral Health Practitioners | Healthcare Practice Compliance | Medical Practice Representation | Medicare and Insurance Audits | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | Physicians and Medical Practices of all Specialties

Frier Levitt recently conducted a survey of non-payment by health insurers using a sample of various in-network healthcare providers to discover patterns of non-payment, underpayment, and recoupments by public and private payors. While the plurality... Read More
Administrative and Insurance Defense Law | All types of single and multi-specialty medical practice groups | Articles | Behavioral Health Practitioners | Dental Practices | Dispensing Physician Practices and Dispensing Physicians | Hospitals and Healthcare Systems | Laboratories | Medical Practice Representation | Medical Spas and Cosmetic Services | Medicare and Insurance Audits | News | Palliative Care, Hospice Care and Home Care | Physicians and Medical Practices of all Specialties | Professional Practice Representation

Frier Levitt Partner Jason N. Silberberg was quoted in a Modern Healthcare article, “More MA Insurer Audits Mean More Scrutiny on Providers” by Lauren Berryman. The Final Rule set to be implemented on February 1, 2023 is likely to increase the... Read More
Articles | Medicare and Insurance Audits | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | News | Publications

On June 15, 2022, the Supreme Court of the United States ruled unanimously in favor of several hospital groups concluding that the Department of Health and Human Services (HHS) exceeded its statutory authority by implementing a discriminatory... Read More
340B Covered Entity and Contract Pharmacy Regulatory and Contract Support | Articles | Healthcare Litigation | Hospitals and Healthcare Systems | Medicare and Insurance Audits

Two practices in Connecticut recently settled large six-figure lawsuits with federal and state agencies resolving allegations of improperly employing an individual who was excluded from all federal healthcare programs. In both instances, the... Read More
Administrative and Insurance Defense Law | Articles | Employment Matters | Federal and State Fraud and Abuse Counseling | Healthcare | Healthcare Law | Healthcare Practice Compliance | Medical Practice Representation | Medicare and Insurance Audits | Physicians and Medical Practices of all Specialties | Professional Practice Representation | White Collar Defense and Government Investigation