Blog - Monthly archives: April 2013

CMS Changes the Number of Files RACs May Request

Posted on Health Care Law News April 30, 2013 by author

Beginning April 15, 2013, additional documentation limits will be implemented by the Centers for Medicare & Medicaid Services (CMS) for Medicare providers subject to the Medicare Fee-for-Service Recovery Audit Program. More specifically, the maximum documentation requests will be quantified per campus. Campus is defined as one or more facilities under the same Tax Identification Number Read more →

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CMS Proposes Additional Fraud Fighting Measures Affecting Medicare Enrollment

Posted on Health Care Law News April 30, 2013 by author

On April 29, 2013, CMS issued a proposed rule that contains a number of measures designed to help curb Medicare fraud, waste, and abuse.  More specifically, the proposed rule would: Increase rewards paid to Medicare beneficiaries and others under the “Incentive Reward Program” whose tips about fraud lead to the recovery of funds; Allow CMS Read more →

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FDA Issues Safety Alert Regarding Fraudulent Botox

Posted on Health Care Law News April 29, 2013 by author

The Food and Drug Administration (FDA) issued a safety alert on April 26, 2013 warning health care providers and the public about fraudulent Botox being sold in the United States.  The fraudulent Botox is being peddled to physicians through blast faxes which offer Botox at discount prices.  The faxes list the names of the seller Read more →

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Medicare Issues Important Change Regarding Ordering and Referring Provider Information on Claim Forms

Posted on Health Care Law News April 21, 2013 by author

Beginning May 1, 2013, claims for all covered Medicare Part B, durable medical equipment, orthotics, and supplies (DMEPOS), and Part A home health agency (HHA) services will be denied when the ordering or referring provider is not enrolled in Medicare, or the claim does not properly list the National Provider Identification (NPI) number for the Read more →

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A Federal District Court Rules That Ignoring Medicare Billing Problems Might Support a “Reverse” False Claims Act Case

Posted on Health Care Law News April 21, 2013 by author

On March 28, 2013, in United States ex rel. Keltner v. Lakeshore Medical Clinic, Ltd., a federal district judge denied the Defendant medical clinic’s Rule 9(b) motion to dismiss the False Claims Act complaint for failing to plead fraud with particularity. The Relator in Keltner was a former billing department employee who alleged that the Read more →

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