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 […]
What Triggered My Medicare Fraud Investigation and Why Am I A Target for Investigators?
The United States National Healthcare Anti-Fraud Association has new data. It shows that taxpayers lose more than $100 billion every year because of Medicare fraud. The scale of fraud and the rising number of fraud cases have made Medicare fraud investigations a priority for the Office of the Inspector General at the Department of Health […]