Palliative care is specialized medical care for people living with a serious illness, such as cancer or heart failure. Patients may receive medical care aimed at providing relief from their symptoms and improving their quality of life, while also... Read More
Early in the COVID-19 outbreak, on April 2, 2020, the Centers for Medicare and Medicaid Services (“CMS”) issued a suspension of most of their audit activities. This suspension was in place until August 5, 2020, when most audit activities... Read More
Physician groups contracting with government-regulated health plans such as Medicare-Advantage Organizations, Medicaid Managed Care Organizations, or ACA Marketplace Individual/Small Group Issuers often enter into capitated payment models with... Read More
With the onset of the pandemic and the flood of claims submitted by providers to government payors in connection with it – such as claims for COVID testing or upwardly (risk) adjusted PMPM capitation payments – comes substantial risk for the... Read More
Following the release of an April 16, 2021 HHS Office of Inspector General (“OIG”) report entitled “Medicare Advantage Compliance Audit of Diagnosis Codes that Humana, Inc. (Contract H1036) Submitted to CMS” (the “OIG Report”), headlines... Read More
The United States Attorney’s Office for the District of Massachusetts recently settled a case against an otolaryngology practice and its management company involving improper billing for certain office visits and procedures. Medicare and... Read More
The United States Attorney’s Office for the District of Connecticut recently announced a civil settlement agreement with a behavioral healthcare organization that provides in-home family therapy and counseling in the greater Hartford area (the... Read More
Over 93% of all doctors accept Medicare, meaning that most physicians have some contact with the Centers for Medicare and Medicaid Services (“CMS”). Like private health insurers, CMS has multiple tools at its disposal to audit providers and... Read More
Healthcare providers across the nation have been battered by audits from the CMS and private payors alike. The CMS, however, has many different types of audits, each with their own wrinkles and potential risks to providers. To understand the risks... Read More
The Appellate Division, Third Department, of the New York State Supreme Court, is now the third judicial department to issue a decision on the question of who is entitled to receive the proceeds from the Medical Liability Mutual Insurance Company... Read More
