Practical Solutions. Personal Service.
The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that brought some needed equity to the way insurance companies reimburse providers and patients for mental healthcare and substance use disorder (MH/SUD) treatment and reimbursement...
The intersection of healthcare and technology has become increasingly complex in recent years, particularly concerning online tracking technologies. The U.S. Department of Health and Human Services (HHS) issued guidance in December 2022, updated in March 2024, to...
By Mathew J. Levy, Esq. Email Mathew To date, the U.S. Department of Health and Human Services’ Office of Civil Rights (“OCR”) has resolved 98% of nearly 257,000 Health Insurance Portability and Accountability Act (“HIPAA”) Privacy Rule complaints. OCR has settled and imposed civil monetary penalties totaling $130,980,482.00. According to the HIPAA Journal, in recent years OCR’s enforcement efforts increased. Particularly, in 2020, OCR settled…
By David A. Zarett, Esq.Email David It has become commonplace for physicians and medical practices to face audits and payment reviews by commercial health insurers and third-party administrators (“TPAs”) under an ERISA plan. If an overpayment is identified, it is not unusual for the carrier or TPA to recoup the funds allegedly owing. One of the tactics used in recovering…
The Office of the Medicaid Inspector General (OMIG) is the state agency within the Department of Health which is charged with investigating compliance with the requirements of the New York Medicaid program. OMIG regularly works with other state and federal government agencies such as the federal Centers for Medicare and Medicaid Services, the New York Bureau of Narcotic Enforcement, and…
By Mathew J. Levy, Esq.Email the Author Today, the sensationalized stories of FBI agents and criminal indictments are the day to day realities of Medicare enforcement faced by every physician. What is Medicare Fraud? First, there are the obvious cases of greed, such as physicians billing for fictitious patients and services never performed and the rendering of unnecessary medical procedures. However,…
By Mathew J. Levy, Esq. & Stacey Lipitz Marder, Esq.Email Mathew Email Stacey In today’s healthcare climate, many providers have been subject to an audit by Centers for Medicare & Medicaid Services (CMS) whereby CMS (through one of its contractors) requests a sample of records and subsequently determines that the documentation does not substantiate the codes billed. Accordingly, CMS requests…
By Mathew J. Levy, Esq.Email Mathew There is perhaps no more frustrating moment in a physician’s career than when a health plan or managed care company notifies him/her that, after the physician has spent countless hours and expended endless efforts to get paid fifty or sixty cents on the dollar for services rendered to his/her patients, the payor is now…
By Mathew J. Levy, Esq.Email Mathew Regrettably, many physicians are receiving a letter from an insurance carrier informing the physician that the physician must repay a substantial amount of money as a result of what has been billed to the insurance carrier and paid without objection. Perhaps the most frustrating part of all is that the physician has billed the…
By: Mathew J. Levy, Esq. & Stacey Lipitz Marder, Esq.Email the Author Introduction The Department of Health and Human Services’ Office of Inspector General (“OIG”) issued a long awaited advisory opinion on May 25, 2012 offering guidance as to the proposed arrangements between Ambulatory Surgery Centers and anesthesia services providers (OIG Advisory Opinion No. 12-06). In today’s healthcare arena, Ambulatory…
