Payor Disputes
Disputes with private insurers, Medicare Advantage plans, and Medicaid MCOs over claim denials and recoupments.
Medicaid Fraud Control Unit Investigations: What Providers Face
A Medicaid Fraud Control Unit investigation can proceed on a civil track, a criminal track, or both. Here is what providers need t…
The Medicare Audit Process: Contractors, Stages, and Deadlines
MAC, RAC, UPIC, SMRC, CERT: which Medicare contractor is auditing you determines the risk. The stages and deadlines every provider…
CMS Imposes Nationwide Moratorium on Hospice and Home Health Enrollments: A Major Escalation in the J.D. Vance Task Force Crackdown
The Centers for Medicare & Medicaid Services (CMS) has imposed a six-month nationwide moratorium on new hospice and home health pr…
The 2025 Healthcare Fraud Takedown Is a Warning Shot for Wound Care Providers
Wound care is now an enforcement priority. The 2025 fraud takedown targets skin substitute billing, graft utilization, and Medicar…
SafeGuard Audits: Don't Let CMS's Contractor Infringe Your Rights
Providers need to know their rights when it comes to investigations and audits by CMS UPIC contractors, such as SafeGuard and Qlar…
Introduction to Medicare Audits
The federal government (HHS-OIG) is prioritizing audits of pharmacy claims in 2024. This signals that increased enforcement action…