Category archive: Medicare

ALERT – Clinical Labs under Scrutiny by OIG

As health care costs rise and providers are faced with challenges to meet the needs and demands of consumers; Medicare looks for questionable payments made to providers to ensure federal dollars for healthcare are spent for medically necessary services as it seeks to reduce fraud and abuse in the provision of health care. One such…

False Claims Act Update – 16 Hospitals to Pay $15.69M Related to Medically Unnecessary Psychotherapy Services

On May 7, 2015, the Department of Justice reported settlement with 16 separate hospitals for medically unnecessary or unreasonable psychotherapy services. The claims under scrutiny were Intensive Outpatient Psychotherapy (IOP) services, which represent a variety of treatment methods. The services, while billed to Medicare by the providers, were performed on the providers’ behalf by Allegiance…

Senate Passes “Fix” to 21% Scheduled Reduction for the Physician Fee Schedule

Please see the notice below from the CMS MLN Connects Network. The Senate has acted to avoid the impact of the Physician Fee Schedule reduction. Attention Health Professionals: Information Regarding the Medicare Access and CHIP Reauthorization Act of 2015 On April 14 , 2015, Congress passed the Medicare Access and CHIP Reauthorization Act of 2015;…

Update on Medicare Physician Fee Schedule

As a result of the Congressional failure to yet adopt a “physician payment fix,” the Centers for Medicare & Medicaid Services (CMS) announced the efforts it will be taking beginning on April 15th, 2015 to alleviate the impact of the 21% decrease in payments required by current law. Meanwhile, CMS will be imposing a 10…

Register Now for Second Medicare Appellant Forum

The second Office of Medicare Hearings and Appeals (OMHA) Medicare Appellant Forum will take place tomorrow, October 29, 2014 from 10 am to 3 pm EST. OMHA is working to provide updates on the backlog of appeals of denied claims, and its initiatives to mitigate the backlog of claims. Recently, CMS offered a settlement option…


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