Mar 24, 2025 | Administrative Law, Health Care, Medicare and Medicaid, Overpayment Appeals
Because Medicare processes over one billion fee-for-service claims annually, it is impossible for CMS and its contractors to review every claim – or even a substantial percentage of claims – on a pre-payment basis. Accordingly, Medicare has set up various...
Dec 10, 2024 | Commercial Payor Audits, Health Care, Housing Development Law, Open Records Act, Overpayment Appeals, Public Corruption, Special Use Permit Filing, Strategic Land Use, Tax Fraud
On December 6, the Department of Justice announced that a federal court ordered Elk Pharmacy Inc., a pharmacy in Elkin, North Carolina, to pay a $500,000 penalty and comply with an injunction to prevent the unlawful dispensing of controlled substances. The injunction...
Jun 28, 2024 | Commercial Payor Audits, Medicare and Medicaid, Overpayment Appeals
As most healthcare providers know, Medicare, like most payors, operates on a “pay and chase” system; meaning, they pay the vast majority of claims promptly, and then audit and attempt to recoup overpayments later should they discover information that calls the...
