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In their efforts to live up to their continuing promises to reduce the deficit, Washington, DC lawmakers are focusing on Medicare Advantage. Specifically, they are investigating billions of dollars that were purportedly generated by overdiagnoses targeting older...
If the federal government believes that they sent a wrongful Medicare payment, they will expect the business to return the funds. This generally begins with an Initial Demand Letter. This first communication from the United States Centers for Medicare and Medicaid...
Physicians throughout the country are finding themselves the recipients of a mailing from the government claiming that they must pay back Medicare payouts related to birth tissue injections. Part of the reason the demand is so frustrating is that it appears the...
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...