Fraud Licensing Overpayments 
AIHC
FEBRUARY 17, 2025
When Audit Managers Knowingly Skew Audit Results Written by Carl J Byron , CCS, CHA, CIFHA, CMDP, CPC, CRAS, ICDCTCM/PCS, OHCC and CPT/03 USAR FA (Ret) Fraud cannot be eliminated. No system is completely fraud-proof, as any system can be bypassed or manipulated. on fraud detection and prevention in healthcare.
Health Law Blog
MAY 22, 2018
Substance Abuse Treatment Center Fraud Scheme Results in Guilty Plea. The Department of Justice recently announced the guilty plea of two individual alcohol and substance abuse treatment center owners for their participation in what DOJ labeled a “multi-million dollar health care fraud and money laundering scheme.”
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Hall Render
DECEMBER 11, 2024
The Proposed Rule would remove the aggravating factors which permit OIG to lengthen periods of exclusion based on the loss of the individual’s or entity’s health care license, and the mitigating factors, which OIG could consider if aggravating factors are applied.
AIHC
SEPTEMBER 5, 2023
Most private insurers and Medicaid cover telebehavioral health care, but check for reimbursement restrictions and obtain professional coding and billing guidance to avoid overpayment situations. This compact does not apply to nurse practitioners (NPs) because they are licensed under state boards of nursing and not medicine.
AIHC
OCTOBER 23, 2024
Third-party audits may result in certification, registration, recognition, an award, license approval, a citation, a fine, or a penalty issued by the third-party organization or an interested party. Corrective action includes refunding overpayments revealed during the audit. This typically involves conducting Root Cause Analysis.
The Health Law Firm Blog
APRIL 19, 2024
By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law In a possibly precedent-setting case, on November 9, 2022, for the first time, an appeals court in New Jersey ruled that plaintiffs in medical malpractice cases do not need an affidavit of merit to file claims against a [.]
The Health Law Firm Blog
SEPTEMBER 20, 2023
By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law Florida's Agency for Health Care Administration (AHCA) has come under fire for failing to make Medicaid final orders accessible to the public. On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against [.]
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