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
Blogs & Articles | Healthcare | Healthcare Law | Managed Care Negotiations and Strategies | Medicare and Insurance Audits | Palliative Care, Hospice Care and Home Care | Professional Practice Representation | Telehealth and Telemedicine

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
All types of single and multi-specialty medical practice groups | Blogs & Articles | COVID-19 Resources | Healthcare | Healthcare Law | Medicare and Insurance Audits

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
Blogs & Articles | Healthcare | Healthcare Law | Healthcare Litigation | Medicare and Insurance Audits | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | Recent Results | Recent Successes | Value Based Care | Value Based Care

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
All types of single and multi-specialty medical practice groups | Blogs & Articles | COVID-19 Resources | Healthcare | Healthcare Law | Healthcare Litigation | Medicare and Insurance Audits

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
All types of single and multi-specialty medical practice groups | Blogs & Articles | Healthcare | Healthcare Law | Healthcare Litigation | Medicare and Insurance Audits | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | News & Press | Value Based Care

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
All types of single and multi-specialty medical practice groups | Blogs & Articles | Healthcare | Healthcare Law | Healthcare Litigation | Medicare and Insurance Audits | White Collar Defense and Government Investigation

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
Behavioral Health Practitioners | Blogs & Articles | Federal and State Fraud and Abuse Counseling | Healthcare | Healthcare Law | Healthcare Practice Compliance | Medicare and Insurance Audits

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
All types of single and multi-specialty medical practice groups | Healthcare | Medicare and Insurance Audits

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
Administrative and Insurance Defense Law | Blogs & Articles | Healthcare Law | Medicare and Insurance Audits