The settlement involved claims that hinged on a set of Medicaid billing regulations that the company believed it had interpreted correctly.
- By David Kopf
- Feb 09, 2023
The DOJ reports that 2022’s False Claims Acts settlements included claims for DME, drugs, home health, managed care, hospitals and physicians.
- By David Kopf
- Feb 09, 2023
Those involved acquired patient referrals and signed doctors’ orders by paying kickbacks to marketers who used overseas call centers to solicit Medicare beneficiaries for unneeded DME.
- By David Kopf
- Feb 09, 2023
An ALJ has overturned all disputed claims from a 2021 HHS OIG report, and Medicare Administrative Contractors have returned 100 percent of the recouped funds to the provider.
- By David Kopf
- Jan 26, 2023
In the first guidance on how it will handle audits after the Covid-19 public health emergency, CMS offers clarifications on dates of service and the nature of the audits.
- By David Kopf
- Nov 10, 2022
Observation Deck
- By Wayne van Halem
- Jun 01, 2022
Requests for additional documentation will be based on the number of claims a provider has in a category.
Business Solutions
Once again, we proofile 10 trends that will shape the HME industry this year. The far-reaching impact of Covid-19 is undeniable, but it’s not the only factor that will define 2022.
- By David Kopf
- Feb 01, 2022
Problem Solvers
Providers will see an increase in claims audits from Medicare and other funding sources in 2022. Audit expert Wayne van Halem offers insights into what they can expect for this year.
- By David Kopf
- Feb 01, 2022
Podcast
Providers will see an increase in claims audits from Medicare and other funding sources in 2022. Audit expert Wayne van Halem offers insights into what they can expect.
- By David Kopf
- Jan 19, 2022
Both audit program contractors have announced new audits for surgical dressings, enteral nutrition, and parenteral nutrition.
Observation Deck
With the COVID-19 audit pause well behind us, multiple indicators show CMS is quickly resuming audits in a big way. What do HME providers need to know?
- By Kelly Grahovac
- Sep 09, 2021
Observation Deck
- By Kelly Grahovac
- Aug 01, 2021
MACs may now conduct post-payment medical reviews of items and services with dates of service after March 2020.
- By David Kopf
- Jun 03, 2021
Several months ago CMS threatened it would resume its claims audits. Now that is happening and audit expert Wayne van Halem provides the details on what’s happening and what providers need to know.
- By David Kopf
- Apr 07, 2021
OMHA reports to AAHomecare that within a year, the number of pending DMEPOS appeals fell by 51 percent.
- By David Kopf
- Nov 19, 2020
Virtual edition of Provider Compliance Focus Group shared information on TPE audits and recommendations it made to the DME MACs.
- By David Kopf
- Oct 22, 2020
Observation Deck
CMS's announcement that audits would resume Aug. 3 was a shock. Then CMS said it would phase audits back in. What are the details?
- By Wayne van Halem
- Oct 01, 2020
The review from CGS is the result of errors and high payouts for four codes, and should impact claims filed prior to the COVID-19 PHE.
- By David Kopf
- Sep 17, 2020
Audit expert Wayne van Halem joins the HME Business podcast to discuss how CMS will phase its audits back in, and how providers should prepare.
- By David Kopf
- Sep 17, 2020