By David A. Zarett, Esq.Email David It has become commonplace for physicians and medical practices to face audits and payment reviews by commercial health insurers and third-party administrators (“TPAs”) under an ERISA plan. If an overpayment is identified, it is not unusual for the carrier or TPA to recoup the funds allegedly owing. One of […]
Continue reading…OMIG Implements Financial Hardship Process for Providers Under Audit
By Seth A. Nadel, Esq.Email Seth The Office of the Medicaid Inspector General (OMIG) is the state agency within the Department of Health which is charged with investigating compliance with the requirements of the New York Medicaid program. OMIG regularly works with other state and federal government agencies such as the federal Centers for Medicare and […]
Continue reading…Understanding The Medicare Fraud Investigation
By Mathew J. Levy, Esq.Email the Author 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 […]
Continue reading…New Guidance Issued by Medicare Involving Extrapolation
By Mathew J. Levy, Esq. & Stacey Lipitz Marder, Esq.Email Mathew Email Stacey 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 […]
Continue reading…Understanding Retrospective Audits and How to Avoid Them
By Mathew J. Levy, Esq.Email Mathew There is perhaps no more frustrating moment in a physician’s career than when a health plan or managed care company notifies him/her that, after the physician has spent countless hours and expended endless efforts to get paid fifty or sixty cents on the dollar for services rendered to his/her […]
Continue reading…Office Based Surgical Procedure Audits – How to Handle Them
By Mathew J. Levy, Esq.Email Mathew Regrettably, many physicians are receiving a letter from an insurance carrier informing the physician that the physician must repay a substantial amount of money as a result of what has been billed to the insurance carrier and paid without objection. Perhaps the most frustrating part of all is that […]
Continue reading…Understanding Financial Arrangements Between Anesthesiologist and Ambulatory Surgical Centers as per the Recent OIG Opinion
By: Mathew J. Levy, Esq. & Stacey Lipitz Marder, Esq.Email the Author Introduction The Department of Health and Human Services’ Office of Inspector General (“OIG”) issued a long awaited advisory opinion on May 25, 2012 offering guidance as to the proposed arrangements between Ambulatory Surgery Centers and anesthesia services providers (OIG Advisory Opinion No. 12-06). […]
Continue reading…Understanding How to Respond to a Visit From an Investigator
By Mathew J. Levy, Esq. & Stacey Lipitz Marder, Esq.Email Mathew Email Stacey 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 […]
Continue reading…Understanding Physician Advertising
By: Mathew J. Levy, Esq. & Stacey Lipitz Marder, Esq.Email the Author Overview: Marketing has taken on a more prominent role in medical practices as a way to attract new patients. As such, physicians need to ensure that their marketing initiatives are in compliance with all of the applicable rules and regulations governing physician advertising, […]
Continue reading…Understanding Third Party Vendor Relationships
By: Mathew J. Levy, Esq. & Stacey Lipitz Marder, Esq.Email the Author Overview: Throughout a physician’s career, he/she will enter into several relationships with third party vendors – billing companies, EMR companies, marketing companies, internet providers, staffing companies and medical device/equipment suppliers to name a few. Prior to entering into these arrangements with third parties […]
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