Entries tagged: healthcare

A Refresher on Medicare Exclusions from the Office of Inspector General

By: William McDonald, Esq.

Posted: December 18th, 2015

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As we near the end of the year, the government will report on how much money it has recovered from healthcare entities for improper Medicare billing.  It is important to remember that, while monetary penalties are serious consequences, egregious overbilling violations may result in the Office of the Inspector General for Health and Human Services […]

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Healthcare Providers with Health Republic Patients Must Act Now to Protect Ability to Receive Payment

By: William McDonald, Esq.

Posted: November 20th, 2015

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Healthcare providers must proactively pursue timely payments under New York’s Prompt Pay Law and conduct credentialing verification to protect their income in the wake of the Health Republic insurance company closing. In October 2015, the New York State Department of Financial Services (DFS) announced that Health Republic would halt coverage at the end of November […]

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Medicare Providers: Don’t Let Identity Theft Cost You Money!

By: William McDonald, Esq.

Posted: October 20th, 2015

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Medicare providers face an alphabet soup of entities seeking to recover “overpayments” from them on behalf of Medicare.  Commonly referred to as Recovery Audit Contractors (“RACs”), these entities include Zone Program Integrity Contractors (“ZPICs”), and they have an aggressive mandate to recover Medicare “overpayments” to providers. We recently represented a physician from whom a RAC […]

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Medicaid Providers: Keep Your Money. Prepare For an OMIG Audit.

By: William McDonald, Esq.

Posted: August 26th, 2015

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Governor Cuomo announced that New York recovered a record-breaking $851 for the Medicaid program in 2013, which led the nation.[1]  Lately, Medicaid providers have been receiving audit letters suggesting that collections will pick up again. New York’s chief Medicaid collection agent is the Office of the Medicaid Inspector General (“OMIG”), and this agency brandishes its […]

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Center for Medicare & Medicaid Services (“CMS”) Announces Guidelines to Ease ICD-10 Implementation

By: William McDonald, Esq.

Posted: July 15th, 2015

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Beginning October 1, 2015, physicians will be required to utilize ICD-10 for claims.  ICD-10 will replace the 35-year old ICD-9 diagnostic system.  According to Acting CMS Administrator Andy Slavitt, “ICD-10 will set the stage for better identification of illness and earlier signs of epidemics, such as Ebola or flu pandemics.” The task of converting to […]

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Pharmaceuticals in our Waters

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Posted: July 8th, 2015

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Published in the Hauppauge Reporter On May 28, 2015, the HIA-LI Environmental/Green Industries Committee presented a well attended program entitled “Pharmaceuticals in Our Waters”.  The program was held at the Education Center of the Suffolk County Water Authority in Hauppauge and was followed by a tour of the lab facility where the Authority does its […]

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Pharmaceutical Disposal – A Work in Progress

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Posted: July 8th, 2015

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Printed in the Suffolk Lawyer The disposal of pharmaceuticals is a growing area of concern in our over-medicated society. According to Citizens Campaign for the Environment, nearly 4 billion prescriptions are filled in the U.S. each year, of which about one third, or 200,000 pounds, are unused. Trace amounts of these drugs enter our surface […]

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Court Strikes Down CMS Prohibition on ‘Per-click’ Equipment Rentals, Upholds ‘Under-Arrangements’ Prohibitions, Under Stark Law

By: William McDonald, Esq.

Posted: June 22nd, 2015

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Freddy Kreuger from Nightmare on Elm Street, Jason from Friday the 13th, and The Exorcist.  This triumvirate struck fear in me as a kid and caused many sleepless nights.  Fast forward to present, and the Stark Law invokes similar fears, with its strict liability and draconian punishments for even inadvertent violations.  The Stark Law prohibits […]

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Queens Court Upholds No-Fault Payment Eligibility for Chiropractic Practice Despite Illegal Fee-Splitting

By: William McDonald, Esq.

Posted: May 20th, 2015

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In H&H Chiropractic Services, P.C. a/a/o Jesus Jimenez v. Metropolitan Property and Casualty Insurance Company[1], a Queens County Civil Court has chipped away at the Malella armor with which insurers have protected themselves since the State Farm Mut. Auto Ins. Co. v. Mallela [2] ruling.  Specifically, using Malella, insurers have convinced courts time and again […]

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Prepayment Review Deadlines Published for Medicare Providers

By: William McDonald, Esq.

Posted: April 20th, 2015

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As we recover from the cold winter, Medicare has prescribed a healthy dose of alphabet soup to Medicare providers and suppliers.  New Change Request 8583 to the Medicare Program Integrity Manual (“MPIM”) imposes a new deadline on Medicare providers and suppliers to provide requested documentation during a prepayment review. Effective April 1, 2015, the MPIM […]

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