Category: Medicaid

Will Trump trump Obamacare?

Donald Trump, whether he is an ace in the hole or a fart in the wind we have to keep on keeping on. November’s presidential election was perhaps the surprise of the century. In the aftermath, everyone on both sides of the aisle have so many questions and are filled with all kinds of speculation. [..]

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Outliers and Auditors

Few people enjoy having someone look over their shoulders and mind their business. Now, more than ever, ‘outsiders’ will be minding your business. Insurance carriers, like Medicaid organizations, are watching dental insurance claims to identify ‘outliers’ or those who stick out as compared to their peers in the number and type of claims submitted for [..]

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Dentist Faces 35 Years in Prison for Billing Errors You Have Probably Made this Week!

On August 11, 2015 the Hartford Currant published a news article that should terrify every dentist who participates with Medicaid. Whether you are a Medicaid provider or not sit down and read this! Dr. Thomas DeRienzo, owner of Plantsville Family Dentistry in Plantsville, Connecticut, “was charged with first-degree larceny by defrauding a public community, second-degree [..]

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Are your Clinical Records Good, Bad or Ugly?

I audit lots and lots of dental records. I like the challenges of auditing detailed records, as I have to pay close attention to identify potential documentation and billing issues. Unfortunately (and all too often) the records I have to audit are not detailed and result in a lot of red ink on my audit [..]

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Federal Government Made $100 Billion in Improper Payments in 2013

Guest Post by: Robert Saltaformaggio, Esq. of  Liles Parker, Attorneys & Counselors at Law According to a new report released by the Government Accountability Office (GAO), the Federal Government made over $100 billion in improper payments in Fiscal Year (FY) 2013.  What is troubling, however, is that this figure could be even higher.  And the largest sources for improper [..]

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No Background Checks? Dentists Could Be Check-mated!

Previously we discussed the implications of providing care under ANY government-subsized Dental program (especially, but not exclusively as a part of the ACA), and how the onus now falls on YOU, the provider, to ensure your on-going eligibility for those funds. In outlining the increasingly stringent oversight attached to this money, you could find yourself [..]

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