The Centers for Medicare & Medicaid Services (CMS) recently announced a proposed rule for the 2026 Medicare Physician Fee Schedule. It introduces significant changes aimed at modernizing Medicare, improving patient care, and reducing costs. These changes will...
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How do I know if a Medicare audit notice is legitimate?
President Donald Trump and his administration have been clear on their intention to crackdown on Medicare overpayments. Whether considering new legislation to help provide additional tools to go after those it believes are seeking fraudulent payments or utilizing...
How can I reduce the risk of a demand for Medicare overpayment?
Every system, no matter how well-intentioned or structured, has its inherent flaws, and Medicare is no exception. Over the years, the complexities and vulnerabilities within the Medicare system have led to instances of fraud, waste, and abuse, prompting the government...
Can drunk driving charges impact my nursing license in NY?
Whether a celebratory drink with colleagues after a long shift or a glass of wine with dinner when out with family, an evening that ends with the flashing lights of a police car and allegations of drunk driving can lead to a whirlwind of legal troubles, especially for...
Understanding causation in False Claims Act cases
The False Claims Act (FCA) serves as a significant mechanism for addressing fraud against the government. However, establishing causation in FCA cases can present considerable challenges. The recent case involving Omni Healthcare and MD Labs underscores the...
Physicians, referrals, and the AKS: Recent case a stark reminder of harsh penalties that come with a violation
Physicians often face the challenge of managing billing and administrative tasks alongside their clinical responsibilities. To alleviate this burden, many seek assistance from third-party services or hire administrative staff. Although this may seem helpful, it is...
4 tips for private practices looking to get hospital contracts
Partnerships between medical groups and hospital systems are always evolving. Groups that are looking to expand are wise to take advantage of this environment as securing new contracts can significantly boost the reputation and revenue of small medical practices....
Is it time to pivot to healthcare? Two things executives should know before making the move
Transitioning into executive roles within the healthcare industry presents unique challenges compared to other sectors. Leaders can bring valuable skillsets from their industry but must also prepare to navigate complex federal regulations, such as the Anti-Kickback...
New York doctor faces decades of imprisonment for healthcare fraud
A federal jury recently found a physician from Queens, New York, guilty of submitting over $24 million in fraudulent claims to Medicare. Allegations included ordering unnecessary laboratory tests and orthotic braces, in exchange for cash kickbacks and bribes. This...
AI in healthcare: Tips to better ensure regulatory compliance
Healthcare leaders throughout the country are implementing various artificial intelligence (AI) systems within their organizations. Use ranges from software to help address scheduling needs to programs that can review tests and flag for additional review. Determining...

