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Health Care Lawyers - Ismail Laher Helping Providers Nationwide with (Medicare) Audits and Investigations

Ish Laher and the Attorneys at Liles Parker, PLLC represent Health Care Providers nationwide. We handles Medicare Audits Defense, Medicare Prepayment and Over Payment issues, CMS Suspension and Revocation Actions,, Compliance Plans, Hippa & Osha Mandatory Training

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  • Hipaa
  • Webinars
  • Violations & Convictions
  • UPIC’s
  • Suspension Actions
  • Revocation Issues
  • RACs – Recovery Audit Contractors
  • Post Payment Reviews
  • Pre Payment Reviews
  • Ish – Ismail Laher & Team
  • Hipaa

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[newsletter]

There are 14 Reasons or grounds for Medicare to issue a revocation letter

September 17, 2015 //  by AdminL

There are 14 Reasons or grounds for Medicare to issue a revocation letter (Each reason is discussed in detail in separate posts..) at 42 CFR 424.535(a), and  in the Program Integrity Manual, Ch 15, Sec 15.27.2

 

  1. Not in Compliance with Medicare Requirements stated in the enrollment application or in the regulations governing enrollment
  2. Excluded/Debarred from Federal Program – provider/supplier, or any owner, managing employee, authorized or delegated official, medical director, supervising physician or “other healthcare personnel”
  3. Felony conviction – ANY felony in last 10 years CMS finds to be detrimental to the Medicare program or its beneficiaries
  4. False or Misleading Information on Application – revocation PLUS fines or imprisonment or both
  5. On-Site Review/Other Reliable Evidence that Requirements Not Met – these are the failed site visits (which usually also list Reason 1 above)
  6. Hardship Exception Denial and Fee Not Paid
  7. Misuse of Billing Number- knowingly let another use your billing number
  8. Abuse of Billing Privileges – billing for deceased beneficiaries (3 or more times), impossible for provider to have rendered services, equipment not available when service that was allegedly provided, or there is a pattern or practice of billing errors
  9. Failure to Report Changes – another option to revoke if physician (or other Part B provider) fails to report adverse action or change in location
  10. Non-Compliance with Documentation Requirements – applies to written orders and certifications and requests for payments for items of DMEPOS and clinical laboratory, imaging, and home health services
  11. Home Health Agency (HHA) Capitalization
  12. Medicaid Billing Privileges Revoked
  13. DEA Certificate/State Prescribing Authority Suspension or Revocation
  14. Improper Prescribing Practices – CMS determines that the physician or eligible professional has a pattern or practice of prescribing Part D drugs that falls into one of the following categories: (i) is abusive or represents a threat to the health and safety of Medicare beneficiaries or both; or (ii) fails to meet Medicare requirements.

 

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Mr. Laher is an attorney in private practice with Liles Parker, PLLC. We counsel and defend Health Care Providers nationwide on Health Law related issues such as Medicare Audits & Fraud Defense, Medicare Prepayment and Over Payment issues, CMS Suspension and Revocation Actions, Practice Specific Gap Analysis, Compliance Plans, Hippa & Osha mandatory training, and with General Counsel and Compliance Officer Services.

Much of the above was originally  prepared/presented by one or more Liles Parker attorneys for use in one or more of the many webinars, presentations, discussions with clients and and subsequently re purposed for use here by ISH (Attorney Ismail Laher)
Attorneys include Jennifer Papapanagiotou, Michael Cook, Robert Liles, David Parker, Andy Lynch, Paul Weidenfeld, Adam Bird,  Lorraine Ater, Les Johnson, Jason Cabell, Leornad Schneider, Richard Pecore, Bethany Meuret, Heidi Kocher, Gloria Frank, Harri Williams, Ismail Laher

Category: Education, General, Revocation IssuesTag: Education, Guidance, Revocation

CMS has the authority to revoke if the the provider or supplier has a pattern of submitting claims that fail to meet Medicare requirements.

August 2, 2017 //  by AdminL

per 42 CFR (statute symbol) 424.535(a)(8)(ii), CMS has the authority to revoke a currently enrolled provider’s or supplier’s Medicare billing privileges

if

CMS determines that the provider or supplier has a pattern of submitting claims that fail to meet Medicare requirements.

Category: Enrollment Issues, Fraud

As required by section 13402(e)(4) of the HITECH Act, the Secretary must post a list of breaches of unsecured protected health information affecting 500 or more individuals. The following breaches have been reported to the Secretary:

July 26, 2017 //  by AdminL

click on Cases Currently Under Investigation: This page lists all breaches reported within the last 24 months that are currently under investigation by the Office for Civil Rights.

source page is https://ocrportal.hhs.gov/ocr/breach/breach_report.jsf

Consumer Information

If you think you may be the victim of identity theft, you may wish to verify the information in your medical record, and/or ask for that information to be corrected, by requesting a copy of your of your health information and/or requesting an amendment to your health information.

For more tools to protect yourself against identity theft after a breach, please visit the Federal Trade Commission’s (FTC) website for additional information.

Category: General

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