Blog - Monthly archives: November 2017

As part of its fight against fraud, waste and abuse, CMS contracted with supplemental medical review contractors to perform and/or provide support for a variety of tasks, including performing audits.  As part of their responsibilities, these contractors perform audits to identify overpayments.  Among the many projects being worked by these contractors, is a current review Read more →

Tags : Medicare Audit

On October 13, 2017, the Department of Justice announced a False Claims Act settlement with First Coast Cardiovascular Institute, a Florida based health clinic, under which the practice will pay $448,821.58 for failing to timely refund $175,000 in overpayments to Medicare, Medicaid, TRICARE, and the Department of Veterans Affairs. The settlement is noteworthy because it Read more →

Tags : False Claims Act

The Firm successfully defended a Chiropractor against allegations that the Chiropractor had engaged in billing fraud and used inadequately trained personnel to provide certain services. The Firm investigated the allegations at issue and prepared a response to the investigative complaint that highlighted evidence that demonstrated that the Chiropractor had acted properly, had not engaged in Read more →

Tags : Letter of Guidance

The Firm successfully defended our LMHC client against allegations that the LHMC engaged in unprofessional conduct; misdiagnosed a client; and engaged in excessive UA testing.  This result is especially notable because the complaint at issue was initiated by a competing provider in the community. The Firm investigated the allegations at issue and prepared a rebuttal Read more →

Tags : Letter of Guidance , Licensed Mental Health Counselor

After submitting a detailed redetermination appeal on behalf of our client’s medical practice, the Firm secured a significant reduction in the overpayment demand – more than a 95% reduction.  In addition to addressing the support for the billed services found in the relevant medical records, the Firm also addressed the statistical sampling methodology used by Read more →

Tags : Medicare Audit