Little Health Law Blog
Our healthcare law firm works with many providers and healthcare practices to assist them in complying with federal, state, and local laws. Our clients often ask what they should do when they discover a billing error or overpayment. Billing errors and overpayments can carry substantial legal risks, so it is important to be compliant when faced with a billing error. This blog covers two considerations that providers and practices should consider when they discover a billing error or overpayment for services covered under Medicare. If you need assistance responding to a billing error or overpayment or would like to discuss this blog post, you may contact our healthcare law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.
First Consideration: Providers Have Sixty Days from Identifying the Overpayment to Report and Return the Overpayment
If a person (e.g., a physician, supplier, or any individual or entity that is not a Medicare patient) receives an overpayment from a Medicare payor, the person generally must report the overpayment (including a description of the reason for the overpayment) and return the overpayment to the relevant payor within sixty days of the date on which the physician or other supplier identified the overpayment (or knowingly received or retained an overpayment). Federal law also contains a “lookback period,” which means that the provider must report and return an overpayment if the provider identifies the overpayment within Continue reading ›
This is the second post in a series related to the Pretrial Diversion Program in Georgia. The first post provided an 
Our healthcare and business law firm works with many providers and other professionals who have been arrested and charged with misdemeanors. Our clients will, of course, hire criminal defense counsel to handle the criminal proceedings but professionals generally hire our firm navigate the professional consequences of an arrest. Many of our clients are first time offenders who are presented with the option of participating in a pretrial diversion program. Whether to participate in such a program should be discussed with criminal defense counsel. This is the first blog post of two on this subject, and it focuses on providing an overview of the Pretrial Diversion Programs in Georgia and the potential impact on a successful participant’s criminal record. The second post will focus on how successful completion may impact a participant’s professional responsibilities thereafter responding to questions relating to the offense on employment, licensing, and credentialing applications. If you have questions regarding this blog post or 
Many of our healthcare and business law firm’s clients periodically face audits by insurance companies or governmental organizations, usually through a contractor. Audits can be unnerving times for a practice to go through. This blog post outlines 3 tips for handling an insurance audit. The Centers for Medicaid and Medicare recently published that the flexibilities allowed during COVID-19 will soon end and practices should ensure compliant safety and billing practices. As a result of this change after two and half years, practices may see increased audits. If you have questions regarding this blog post or 
Many of our healthcare and business law firm’s clients are in the business of renting expensive medical equipment for use by medical practices. Generally, these arrangements raise compliance questions under 
to audit providers suspected of fraud. UPIC contracts combine Zone Program Integrity Contractors (ZPIC’s) and Medicaid Integrity Contractors (MIC’s) to coordinate Medicare and Medicaid auditing. UPIC’s focus primarily on Medicare claims, and seek to distinguish between provider billing errors or fraud.
As technology improves the ability for providers to communicate, existing healthcare laws will continue to be put to the test. Now, a new call for care coordination is driving quality improvement initiatives for physicians and hospitals. In 2018, U.S. Department of Health and Human Services (HHS) launched its initiative “Regulatory Sprint to Coordinated Care,” to facilitate value-based healthcare and promote effective communication strategies between physicians. The Regulatory Sprint seeks to increase a patient’s ability to understand their treatment plan, promote coordination between providers, establish incentives for providers to coordinate efficient care, and encourage information-sharing between providers and facilities.
Healthcare fraud attributable to nurses, hospitals, pharmacists, equipment providers and doctors, contributes to the high cost of medical care. For this and other reasons, fraud continues to be a hot topic in the healthcare industry. Recently, there have been numerous headlines regarding Medicare, Medicaid, and private insurance company investigations of providers for improper billing practices. Accusations stem from both whistleblowers and audits, making it difficult for providers to hide behind fraudulent billing practices. With numerous investigations in the spotlight in recent months, providers should be alert and act to ensure that they are compliant with the law.