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The federal government chose to ease enforcement of certain regulations during the COVID-19 pandemic, but the Eliminating Kickbacks in Recovery Act (EKRA) was not one of them. This provision within the Substance Use-Disorder Prevention that Promotes Opioid Recovery...
The False Claims Act (FCA) is a federal law that provides accountability for anyone that submits false claims to the government. This law applies to any hospital or healthcare provider who submits claims for payment from Medicare or Medicaid, along with other...
The law is constantly evolving. Arguably, this is a good thing. In many cases this evolution helps to better ensure the laws remain relevant. However, in some cases the changes may cause more problems than they fix. That is the issue diagnostic labs are currently...
United States Attorney’s Offices throughout the country continue their aggressive pursuit of physicians and other medical professionals who fail to follow the regulations set out in the False Claims Act (FCA). The feds have found success, reportingly pursuing the...
There are circumstances that result in a surgeon needing to perform two procedures in one day. Unfortunately, unless certain criteria are met, the surgeon in this position could find themselves accused by the feds of fraudulent billing practices. Case example: OIG...
It is not uncommon for healthcare providers to receive a demand for overpayment from Medicare. Those who find themselves in this situation may wonder what their options are. In some cases, it may make sense to pay the bill and move on. In others, the amount demanded...
There are various regulations that help better ensure patient safety when compounding medications. Although mostly beneficial, these regulations can prove challenging for pharmacies as well as diagnostic testing and reference labs. The government will conduct audits...
The pandemic fueled change in our family lives, our working lives and even the marketplace as a whole. The pandemic changed every marketplace within our communities, from retail to healthcare. One of the most visible changes within the healthcare marketplace is the...
In what the Health and Human Services Office of Inspector General is calling the largest audit penalty every imposed on a Medicare Advantage company, the feds have recently completed and an audit and are calling on the company to pay over $200 million back in Medicare...
An overpayment recovery request from Medicare or a private carrier essentially means the payer is stating that they want their money back. They already sent your group payment for a claim, but now they have decided the payment was either too much or unwarranted. It is...
