Allegations of a Medicare overpayment are not uncommon. The government estimates that it overpays millions in Medicare claims to physicians and healthcare providers every single year. The government states these overpayments are of the result of a place-of-service...
The Department of Health and Human Services (HHS) recently announced that it is digging into risk adjustment tactics it claims may have led to overpayments. The review will focus specifically on certain Medicare Advantage (MA) plans. Secretary Xavier Becerra noted the...
When the Centers for Medicare and Medicaid Services (CMS) identifies an overpayment, it views the overpayment as a debt owed by the practice or health care organization to the federal government. These alleged overpayments can happen for any number of reasons,...
The United States Department of Medicare and Medicaid Services (CMS) uses a number of different resources to aid in the completion of its many operations. This includes contracts with different entities to help determine if the CMS made overpayments to health care...
A group of Texas hospitals recently joined others from Florida, Georgia, Alabama, Tennessee, and other states where the United States Health and Human Services (HHS) did not expand Medicaid to demand payment. The hospitals state they did not receive payment for care...
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...
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...
The United States Department of Health and Human Services (HHS) Office of Inspector General recently released its findings from an audit of an HCA Healthcare owned facility operating out of Las Vegas. According to their findings, the facility owes the feds millions....
