Landmark results in federal cases nationwide

Resources

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

When your Durable Medical Equipment (DME) business faces government scrutiny, it can threaten reimbursement, enrollment, and even your freedom. CMS, MACs, RACs, UPICs, OIG, and the DOJ actively pursue suspected patterns of DME equipment fraud to protect Medicare and Medicaid funds. What may begin as an administrative audit can quickly escalate into civil or criminal [...]

What Should I Do When FBI Agents Show Up at My Home to Interview Me?

If the FBI visits your home or office to interview you about a potential crime, this guide explains the steps to take to protect your rights and prevent potential self-incrimination. Key Takeaways of Steps to Take When The FBI Visits You If the FBI approaches you for an interview at your home or workplace, keeping [...]