Category: Medicaid

If Birds Of A Feather Flock Together, Your “Flock” Could Cost You!

There are many uncertainties about the Affordable Care Act. Despite the uncertainties, there are some parts of Obamacare that are crystal clear…especially when it comes to MONEY. Let’s look at a one of them. Many states are expanding their Medicaid programs, which will extend eligibility to millions. Medicaid programs provide Dental care for children. This, [..]

Read More

Dentists Get Stretched On The RAC

In an experiment several years ago the Federal government piloted a program to efficiently identify underpayments, overpayments and identify fraudulent activity related the Medicare program. The Recover Audit Contractor (RAC) program was born. Under RAC private auditors review claims data and identify underpayment, overpayments, and indicators of fraud. The contractors propose a particular issue of [..]

Read More

More Surprises from the Affordable Care Act

ACA section 10606(a) affirms the applicability of the Federal Sentencing Guidelines, which I previously discussed.  Additionally, in 10606(b) states, “With respect to violations of this section (Healthcare Fraud), a person need not have actual knowledge of this section or specific intent to commit a violation of this section.’’ Let this simmer for a second… To [..]

Read More

Medicaid Provider, are you (or your employees) excluded and don’t even know it?

In a previous article where I discussed the purpose of a compliance program I mentioned that recent enforcement/ prosecution trends indicate that the government is not necessarily seeking prison time for convictions. The trend is to exclude providers from participation in the Federal health care programs and require repayment of Civil Monetary Penalties under the [..]

Read More

How can a Compliance Program Save your Bacon?

In 2011 the Federal Sentencing Guidelines were revised to strengthen that due consideration be given to organizations found guilty of wrongdoing when an organization has a “reasonably effective compliance program”. This does not require that a compliance program be perfect, just that there is a great likelihood that a situation that is not caught likely [..]

Read More

A Closer Look at the Core Elements of a Dental Compliance Program

In a previous article I identified for you the Office of the Inspector General’s recommended core elements for establishing a compliance program. Let’s quickly review them and then we will take a closer look at what they mean for your dental practice.   Conducting internal monitoring and auditing through the performance of periodic audits Implementing [..]

Read More