ZPIC Audits

UPIC / ZPIC Referrals of MDs and NPs to State Boards!

(June 9, 2017):  You aren’t paranoid, your utilization, coding and billing practices... 

ZPIC Audit: Will Your Case be Referred to DOJ or HHS-OIG for Fraud?

(March 10, 2016): Has your practice, home health or hospice received an audit letter... 

Providers Have a New Timeframe to Respond to ADRs

(4/7/15)  On February 4, 2015, the Centers for Medicare and Medicaid Services (CMS)... 

ZPIC Prepayment Review

(September 15, 2012): Over the last year, Zone Program Integrity Contractors (ZPICs)... 

OIG Cautions About ZPIC Conflict of Interest

From LilesParker.com ZPICs Have Conflict of Interest HHS-OIG recently released a... 

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Medicare Audits

ZPIC Update: The Impact of Being Placed on Medicare Prepayment Review.

(March 9, 2016): Why have the number of prepayment reviews by Medicare contractors... 

Medical Director Agreements: Compensation Arrangements are Under the Microscope by HHS-OIG

(June 11, 2015): After a hiatus of almost a year, the Department of Health and Human... 

New Medicare Penalties with Quality and Safety Incentive Programs

(April 30, 2015): Starting this year, the Centers for Medicare and Medicaid Services... 

Understanding Prepayment Review in 2015

The Centers for Medicare & Medicaid (CMS) has instituted several methods to help... 

CMS Guidance on the Role of the Medical Director

Long term care facilities are required[1] to employ a physician to serve as its medical... 

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HEAT Enforcement

South Texas Health Care Providers Remain Under Considerable Scrutiny by HEAT Prosecutors and Investigators – Compliance Isn’t Optional – It’s Essential in 2011.

(January 6, 2011):  Three Houston-area residents, one of whom is a physician, were sentenced to prison on January 4th for their roles in a multi-million dollar durable medical equipment (DME) Medicare fraud scheme.  Each of the three defendants were also ordered to pay restitution to the Federal government, in amounts ranging from $29,052 to $1.4... [Read more of this review]

Home Health Agency “Patient Recruiter” Sentenced to 63 Months in Prison for Allegedly Committing Health Care Fraud

(October 18, 2010):  The U.S. Attorney’s Office for the Eastern District of Michigan, working with the FBI and HHS-OIG has announced the sentencing of yet another defendant convicted of home health fraud.  As the Department of Justice’s Press Release reflects, the defendant, a nurse who worked as a “patient recruiter“ and operator... [Read more of this review]

President Obama’s 2011 Funding Request Provides for Expansion of the HEAT Program to Additional Cities

(October 4, 2010):  As DOJ has recently noted in its own blog, over the last Fiscal Year, DOJ (including its 94 U.S. Attorneys’ Offices),  HHS’ Office of Inspector General (HHS-OIG), and the Centers for Medicare and Medicaid Services (CMS), have been extraordinarily active in jointly pursuing  health care providers allegedly engaging in fraud... [Read more of this review]

Medicare Fraud Strike Force Operation Leads to Charges against 94 Defendants, including 4 in South Texas

(July 17, 2010): Yesterday, the Department of Justice (DOJ) announced charges against 94 physicians, medical assistants, and health care company owners and executives in connection with alleged false Medicare claims amounting to more than $251 million.  24 defendants from Miami account for approximately $103 million of that amount.  Four defendants... [Read more of this review]

Texas Psychiatrist Indicted and Arrested

(July 9, 2010):  On June 14, 2010 the U.S. Attorney’s Office for the Western District of Texas announced that a Federal Grand Jury had returned a 99-count indictment against a pain management physician who operated clinics in San Antonio and El Paso.  The physician was charged with 21 counts of health care fraud, 20 counts of false statements relating... [Read more of this review]

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