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Resources

The Complete Guide to Healthcare Fraud Defense

For those facing healthcare fraud allegations, this complete guide to healthcare fraud defense explains the laws, the evidence collection process and the available defense options. [...]

MAC Audits vs. UPIC Audits: What Medical Professionals Need to Know

Medicare’s program integrity framework relies on multiple layers of auditing activity. For most providers, the two audit types most likely to affect day-to-day operations are those conducted by Medicare Administrative Contractors (MACs) and Unified Program Integrity Contractors (UPICs). Though both are federal audit mechanisms operating under the authority of the Centers for Medicare & Medicaid [...]

UPIC Audits Guide for Healthcare Providers

A UPIC audit is an investigation focused on uncovering healthcare fraud. From handling unannounced site visits to understanding the dangers of statistical extrapolation, this guide details the critical steps you must take to protect your practice from payment suspensions and federal prosecution. [...]

What is the Line Between Medical Billing Errors and Healthcare Fraud?

Learn how federal law separates medical billing from from simple billing errors. You'll discover the role of intent and the steps you can take to protect your healthcare practice during billing fraud investigations. [...]

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 [...]

DME Supplier Audits, Fraud Allegations, and Consequences

Key Takeaways: DME Supplier Audits You Are a Primary Target: With $1.9 billion in improper payments in FY 2024, CMS and its contractors treat DMEPOS suppliers as high-priority targets for audits and enforcement. Audits Escalate Quickly: What starts as a routine administrative review (MAC or RAC) can easily trigger UPIC, OIG, or DOJ investigations if [...]