Program Integrity Contractors Upics News Today

On 5 March 2024, in an issue of first impression in the District of South Carolina, a district court judge overseeing judicial review of a final agency decision in a Medicare claims...

The Centers for Medicare and Medicaid Services (CMS) issued a final rule on the use of extrapolation to determine overpayments in risk adjustment data validation (RADV) audits of...

Introduction - On 6 December 2022, the Department of Health and Human Services Office of Inspector General (HHS-OIG) issued a report (Report) that summarized findings of HHS-OIG’s...

Below is Alston & Bird’s Health Care Week in Review, which provides a synopsis of the latest news in health care regulations, notices, and guidance; federal legislation and...

A Qlarant audit is a serious event in the life of a healthcare provider and company. This auditing contractor claims that it is a non-profit company that works on behalf of the...

If you are a healthcare provider, you are bound to get audited at some point. Who conducts that audit (this includes federal authorities such as the Department of Health and Human...

While facing the unprecedented challenges of the COVID-19 pandemic, hospice and home health providers also continue to weather a deluge of audits and recoupments from CMS contractors....

Government enforcement agencies are primed to make healthcare provider upcoding a government focus as it shifts from COVID-related conduct to resuming other enforcement priorities.

A pair of recent reports issued by the Health and Human Services Office of Inspector General (“OIG”) and Cotiviti, a Centers for Medicare and Medicaid Services (“CMS”) Recovery Audit...

Reports issued by Health & Human Services Office of Inspector General OIG and Cotiviti, a Centers for Medicare & Medicaid Services CMS Recovery Audit Contractor indicate resumed regulatory focus on hospital and physician practice upcoding as government enforcement priorities expand