High Quality Services And Personal Attention
By Mathew J. Levy, Esq. & Stephen Cucolo, Esq. Did you know that waving a co-pay could result in criminal or civil penalties? That is exactly what happened to one company, BioTek reMEDys Inc. (BioTek) In a recent settlement with the Department of Health and Human...
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…
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 Introduction Management Services Organizations (“MSOs”) can provide real and appreciable benefits to busy practitioners, allowing them to provide better patient care, unencumbered by the demands of micromanaging the business. MSOs can also be a productive venture for those who own and operate them. The ability to provide a turn-key office for busy physicians,…
By Mathew J. Levy, Esq. & Stacey Lipitz Marder, Esq.,Weiss Zarett Brofman Sonnenklar & Levy, P.C. Email the Author SERIES DESCRIPTION: 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…
By: Mathew J. Levy, Esq. & Stacey Lipitz Marder, Esq.Weiss Zarett Brofman Sonnenklar & Levy, P.C.Email the Author Providers rendering services under No-Fault are probably familiar with Examinations Under Oath (EUOs). As per applicable No-Fault regulations, by accepting a patient’s assignment of benefits, an insurance company may demand that a provider appear before an EUO in order to verify the…
By David A. Zarett, Esq.Email David Recently, physicians in the Central New York and Adirondack areas were contacted by the Medicaid Fraud Control Unit of the New York State Attorney General’s Office (“MFCU”) demanding repayment of Medicaid funds allegedly paid under a fee-splitting arrangement. In short, MFCU claims that the physicians paid a percentage of Medicaid collections to their billing collection…
By: David A. Zarett, Esq. and Lijia Sanchez, Esq.Weiss Zarett Brofman Sonnenklar & Levy, P.C. Effective January 6, 2017, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HSS) issued a final rule that restructures its civil monetary penalty (CMP) regulations, shedding light on the agency’s review process in certain enforcement actions, particularly its…
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…