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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Understanding Retrospective Audits and How to Avoid Them

By: Mathew J. Levy, Esq. & Stacey Lipitz Marder, Esq.Weiss Zarett Brofman Sonnenklar & Levy, P.C.Email the Author 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 […]

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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). […]

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Understanding Financial Arrangements Between Chiropractors and Other Licensed Healthcare Professionals

By: Mathew J. Levy, Esq. & Stacey Lipitz Marder, Esq.Email the Author Overview: For many chiropractors, there are several benefits associated with working with physicians and other licensed healthcare professionals from both a clinical and financial perspective.  However, prior to entering into these business structures, chiropractors must evaluate the legal implications as there are several […]

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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 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, […]

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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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