Medicare Payment Suspensions: What Healthcare Providers Need to Know in Response
Pursuant to 42 C.F.R. §405.371(a)-(c), Medicare payments to participating providers may be suspended, offset, or recouped by CMS or one of its authorized contractors This post explains the legal framework governing Medicare payment suspensions, the circumstances under which they are imposed, and the steps providers should take if they receive a suspension notice. Background: A […]
What Is Medicare Exclusion?
A Medicare exclusion is an administrative action by the Office of Inspector General (OIG) that bans a healthcare provider or business from participating in federal healthcare programs like Medicare and Medicaid. Consequently, these programs will not pay for any services or items ordered, prescribed, or provided by the excluded party. If you are facing an […]
Medicare Fraud Investigations: Medicare Targets and Triggers for CMS Criminal Prosecutions
The Centers for Medicare & Medicaid Services (CMS), working alongside Unified Program Integrity Contractors (UPICs) and Medicare Administrative Contractors (MACs), triggers an immediate fraud action when an allegation possesses indicia of reliability, under 42 C.F.R. § 405.370, The United States National Healthcare Anti-Fraud Association has new data. It shows that taxpayers lose more than $100 […]