Private practices often rely on Medicare. It provides coverage for many patients and payment on claims is relatively prompt. Unfortunately, issues with claims can lead to major headaches. In a recent example, a medical product manufacturer’s rebate practices could...
Medicare Overpayment
Three things medical providers should know to prevent Medicare overpayment investigations
Medicare overpayment issues can have significant financial and legal implications for healthcare providers. Unfortunately, such claims are not uncommon and may be on the rise. A recent study predicts that Medicare overpayments may increase by 20% in 2023, translating...
The current state of Medicare Advantage
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...
What happens when the feds send a Medicare overpayment demand letter?
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...
3 questions about an overpayment demand letters for birth tissue injections
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...
Common mistakes in Medicare overpayment cases
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...
What steps should I take after I get a Medicare overpayment notification?
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...
What should I do if I get a Medicare overpayment notification?
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,...
What should I do if my organization gets a letter from a RAC?
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...
TX hospital joins dozens to sue HHS for reimbursement
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...