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....
The government has increased its focus on Medicare overpayments to home health agencies (HHAs). These healthcare facilities can reduce the risk of these allegations by avoiding the most common complaints. The United States Department of Health and Human Services (HHS)...
The United States Department of Health and Human Services Office of Inspector General (OIG) stated in a recent report that it has identified significant overpayments to home health agencies (HHAs). The agency states that these overpayments are primarily from improper...
The United States Department of Justice (DOJ) recently accused New York health service company Cigna of over $1 billion in Medicare overpayments from 2012 through 2017. The feds state the insurance provider intentionally misrepresented health conditions to justify...
Recently, a Medicare certified home health agency received a letter from CMS alleging that the home health agency received an overpayment in the amount of $3,351,149.00. prepared a Redetermination appeal that contested the overpayment by...
