Welcome to the complex world of healthcare compliance! If you're new to the industry, navigating the laws and regulations can be daunting if for no other reason than there are just so many to choose from, so we are going to pick our poison of...
Almost all of the medical practitioners and practices I have worked with over the years have employed third-party billing companies to help with insurance claims submission and claims management. To say the quality of these third-party billing companies varies greatly would be like saying the...
One common refrain I try to express to all of my healthcare clients is the importance of not letting the perfect be the enemy of the good. When dealing with healthcare compliance, government agencies and commercial insurance special investigative units have done a wonderful job...
Imagine the following scenario (this is based on a true story, but no names have been mentioned for a reason….I like the mystery!) No seriously, this happens with some regularity. You are a medical worker at a HIPAA covered entity (say a doctor’s office). You use...
On October 25, 2018, the Kaiser Family Foundation issued a report entitled “States Focus on Quality and Outcomes Amid Waiver Changes: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2018 and 2019.” A copy of the full report can be accessed here. ...
It usually starts with a telephone call from your friendly state Medicaid Fraud Control Unit (MFCU). The voice on the other end of the phone tells you that they are going to come out and audit your Medicaid billing documents and want to find a...
Every state in the United States, except North Dakota, has a Medicaid Fraud Control Unit (“MFCU”) that’s mission is to investigate and prosecute Medicaid provider fraud and patient abuse, and neglect. MFCUs are a creation of federal statute and receive 75% of their funding for...
If your home care and/or home health agency is located in a state with a well-developed Medicaid waiver program, becoming a provider can help you diversify revenue streams and increase your census. While most states have a waiver program or make home and community based...
In the September 18, 2018 Federal Register, at pages 47246-47275, the Department of Veterans Affairs (VA) announced its final rule regarding, among other things, calculation of income and assets for need-based programs and in-home services to veterans. The VA had proposed to set a nationwide...