Category Archives: Medicare

29 Oct

How to Avoid Medicare Payment Interruptions After January 1, 2020

Attention Medicare providers! if you want to continue receiving Medicare payments without delay please ensure that your practice or billing provider is using MBIs for all Medicare transactions as soon as possible and prior to January 1, 2020. As you may recall, The Centers for Medicare and Medicaid Services (CMS) is requiring that “physicians, providers,

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18 Oct

Changes to the Amount in Controversy Thresholds for Medicare Appeals

Beginning on or after January 1, 2020, the amount in controversy needed by Medicare providers will change as follows: $170 for Administrative Law Judge (ALJ) hearings. (2019 – $160) $1,670 for judicial review (2019 – $1,630) The Center for Medicare and Medicaid Services (CMS) every year announces annual adjustments to the amount in controversy threshold

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11 Feb

Home Health Agencies no longer under CMS moratorium

As of January 30, 2019, there are no active Medicare Provider Enrollment Moratoria in any State, including Florida, or U.S. territories. On July 31, 2013, the the Centers for Medicare and Medicaid Services (CMS) first issued a temporary moratorium which affected providers who desired to or where in the process of enrolling as a home

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11 Feb

How to respond to a Final Audit Report (FAR)

Florida health care providers that provide services to Medicaid recipients are likely, at some point, to receive an audit of their claims submitted to the Medicaid program for reimbursement. Some providers will, for any number of reasons, receive a preliminary audit report detailing the Agency for Health Care Administration’s (Agency) findings as well as setting

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07 Feb

Responding to Record Requests on a Timely Basis.

Health care providers are increasingly seeing request for records from all types of payors including but not limited Medicaid, Medicare and commercial insurance providers. The basis for receiving a requests for records could be as a result on any number of reasons, including compliance, aberrant billing practices or as a result of a ZPIC audit

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07 Feb

Florida Behavior Analysis Services – Overpayments

The Florida Agency for Health Care Administration (Agency), Medicaid Program Integrity (MPI) has and is undergoing review of several Behavior Analysis Services providers regarding their Medicaid reimbursement claims for services rendered. MPI is reviewing said claims in order to insure compliance with the program’s Florida Medicaid Behavior Analysis Services Coverage Policy dated October 2017, including

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04 Mar

Hospital enters $85 million settlement for alleged Stark Law violations

Halifax Hospital agreed Monday, March 3, 2014, to settle a whistleblower case for alleged Stark Law violations with the U.S. Justice Department in the amount of $85 million — an amount so large it is more than twice the previous recors for hospital systems accused of Medicare fraud.  The Daytona Beach, Florida  hospital is accused of

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23 Aug

Gaitan Law Group Successfully Reduces a $736,305.93 Overpayment to $6,826.00

  CMS sought recovery of an alleged overpayment in excess of $730,000 from a diagnostic laboratory, upon the conclusion and recommendation of Safeguard Services (SGS) to deny all claims submitted for 3,006 Medicare beneficiaries.  Mr. Gaitan and Mr. Suarez, of our health care practice group, appealed the overpayment claim through the reconsideration (second level appeal),

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17 Apr

HHS reaches $100,000 settlement with Phoenix Cardiac Surgery for Lack of HIPAA Safeguards

Phoenix Cardiac Surgery, P.C., of Phoenix and Prescott, Arizona, has agreed to pay the U.S. Department of Health and Human Services (HHS) a $100,000 settlement and take corrective action to implement policies and procedures to safeguard the protected health information of its patients. The settlement with the physician practice follows an extensive investigation by the HHS Office for Civil Rights (OCR) for potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules. For assistance developing a HIPAA compliance program or responding to a HIPAA breach, contact Rafael A. Gaitan, Esq. Mr. Gaitan has over 15 years experience in the health care industry and regularly counsels physician practices on regulatory matters including HIPAA and the HITECH rules.

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