Payor Disputes
Disputes with private insurers, Medicare Advantage plans, and Medicaid MCOs over claim denials and recoupments.
Medicare Advantage Plan Audits Versus Traditional Medicare
Medicare Advantage plans audit under provider contracts and RADV rules, not Medicare regulations, which changes both the audit tri…
Ownership Disclosure Requirements in Medicaid Enrollment
Medicaid providers must disclose 5 percent owners and managing employees, and nursing facilities must now name private equity and…
Hospice Medicare Audits and Eligibility Challenges
CMS and OIG are scrutinizing hospice terminal prognosis documentation, long lengths of stay, and the aggregate cap under 42 CFR 41…
MFCU Subpoenas: Responding Without Making It Worse
MFCU subpoenas carry civil and criminal exposure at once. How to negotiate scope, review for privilege, and avoid the mistakes tha…
Ohio Medicaid Audits: Process and Deadlines
How Ohio Medicaid audits proceed from an ODM or SURS notice through reconsideration, adjudication, and appeal, and what providers…
Pennsylvania Medicaid Audits and Provider Appeals
How DHS audits Pennsylvania Medicaid providers, the repayment timeline, and the 30-day deadline to appeal to the Bureau of Hearing…
Reassignment of Medicare Benefits: Where Groups Get Exposed
Reassignment shifts Medicare billing rights to the group, and with it, audit and overpayment exposure the group may not see coming…
Reactivating a Deactivated Medicare Billing Number
Deactivation is not revocation. What triggers a deactivated Medicare billing number, how to reactivate it, and the claims gap that…
Molecular Laboratories Increasingly Turn to Health Law Alliance for Assistance with CPT Code 87798 Level 3 Denials, Payment Suspensions, and UPIC Audits
Leading healthcare law firm employs former Medicare and UPIC investigators, attorney-clinicians, federal and state prosecutors, an…