Understanding The Medicare Fraud Investigation

By Mathew J. Levy, Esq. Today, the sensationalized stories of FBI agents and criminal indictments are the day to day realities of Medicare enforcement faced by every physician. What is Medicare Fraud? First, there are the obvious cases of greed, such as physicians billing for fictitious patients and services never performed and the rendering of unnecessary […]

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New Guidance Issued by Medicare Involving Extrapolation

By Mathew J. Levy, Esq. & Stacey Lipitz Marder, Esq. In today’s healthcare climate, many providers have been subject to an audit by Centers for Medicare & Medicaid Services (CMS) whereby CMS (through one of its contractors) requests a sample of records and subsequently determines that the documentation does not substantiate the codes billed. Accordingly, […]

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Featured in the Journal of the Nassau County Bar Association June 2018: Understanding the Legal Implications Involving Management Services Organizations

By Mathew J. Levy, Esq., Seth A. Nadel, Esq. & Stacey Lipitz Marder, Esq. Weiss Zarett Brofman Sonnenklar & Levy, P.C. Introduction Management Services Organizations (“MSOs”) can provide real and appreciable benefits to busy practitioners, allowing them to provide better patient care, unencumbered by the demands of micromanaging the business. MSOs can also be a […]

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Understanding EUOS and New Guidance Involving Corporate Structure

By: Mathew J. Levy, Esq. & Stacey Lipitz Marder, Esq.Weiss Zarett Brofman Sonnenklar & Levy, P.C.Email the Author Providers rendering services under No-Fault are probably familiar with Examinations Under Oath (EUOs). As per applicable No-Fault regulations, by accepting a patient’s assignment of benefits, an insurance company may demand that a provider appear before an EUO […]

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Medicaid Fraud Control Unit Alleges Illegal Fee-Splitting by New York Physicians in Billing Vendor Arrangements

By: David A. Zarett, Esq. & Seth A. Nadel, Esq.Weiss Zarett Brofman Sonnenklar & Levy, P.C. Recently, physicians in the Central New York and Adirondack areas were contacted by the Medicaid Fraud Control Unit of the New York State Attorney General’s Office (“MFCU”) demanding repayment of Medicaid funds allegedly paid under a fee-splitting arrangement. In short, […]

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OIG’s New Civil Monetary Penalties Regulations Offer Insight into the Agency’s Decision-Making Process

By: David A. Zarett, Esq. and Lijia Sanchez, Esq.Weiss Zarett Brofman Sonnenklar & Levy, P.C. Effective January 6, 2017, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HSS) issued a final rule that restructures its civil monetary penalty (CMP) regulations, shedding light on the agency’s review process in […]

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Understanding How to Respond to a Visit From an Investigator

By: Mathew J. Levy, Esq. & Stacey Lipitz Marder, Esq.Email the Author Introduction: As the government and private payors continue to invest resources into combatting fraud and abuse in the healthcare system, many practices are being faced with unexpected visits from state and federal government and private investigators, including but not limited to investigators from […]

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Understanding Prepayment Audit Reviews

By: Mathew J. Levy, Esq. & Stacey Lipitz Marder, Esq.Email the Author Overview: The unfortunate reality is that the cost of running a medical practice is increasing while reimbursement from third party payers is decreasing.  In order to survive, it is crucial that physicians get paid for the services rendered to their patients in a […]

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