3, 4, You better shut your door. In 2024, HHS estimates that Medicare was overpaid $32 billion. Medicaid? Another $31 billion. But let’s be clear—“improper” doesn’t mean “fraudulent.” It often just means a contractor (with all the clinical experience of
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Who Can Opt Out of Medicare: It’s a Club, and Not Everyone’s Invited
Have you ever dreamed of opting out of Medicare? Of finally breaking free from the labyrinth of CMS regulations, endless audits, pre- and post-payment reviews, and the looming threat of recoupments years after services were rendered? Imagine a world where
From IJ to OK: How to Legally Navigate the Worst Day of Your Facility’s Life
In my years defending nursing homes, assisted living facilities, group homes, and other long-term care providers, I’ve seen the same story unfold too many times: a good facility, staffed with caring professionals, finds itself blindsided by a licensing investigation or
Detecting Fraud? – Or Private Companies Gone Wild?
A new wave of Recovery Audit Contractors (RACs) and Unified Program Integrity Contractors (UPICs) have swept across the nation, empowered to root out fraud in Medicare and Medicaid. While safeguarding taxpayer dollars is a legitimate and necessary objective, the federal
Confess, Cooperate, Clean Up – DOJ’s Compliance Deal of the Decade
Let’s face it—most healthcare organizations would rather do a group root canal than voluntarily tell the government they’ve made a mistake. The phrase “self-disclosure” doesn’t exactly scream “great career move,” and the idea of dialing up DOJ to say, “Hey,
The Forgotten Innocent: When Health Care Providers Are Wrongly Accused of Faud!
Across the country, thousands of Medicare and Medicaid health care providers dedicate their lives to caring for vulnerable populations—seniors, people with disabilities, and low-income individuals who rely on government-sponsored health care to survive. Obviously I am not telling you novel
Compliance. Because You Won’t Make It in Prison!
HHS Restructuring and Workforce Reduction: Key Changes and Uncertainties
By Miranda Franco, Senior Policy Advisor, Holland & Knight LLP On April 1, 2025, the U.S. Department of Health and Human Services (HHS) began implementing a significant reduction in force (RIF) following an announcement by HHS outlining a “dramatic
Signed, Sealed, Exonerated: When a Law Firm Letterhead Sends the Auditors Packing
Most of my clients don’t call me because things are going well. No one rings up their health care audit lawyer just to say, “Hey, just wanted you to know I’m thriving!”
No, they call because they’ve received The Letter.
Providers Under Siege: The Escalating Burden of Medicare Audits and the Threat of the False Claims Act
Healthcare providers have long navigated the complex world of Medicare audits, working diligently to meet billing standards, document patient care thoroughly, and respond to regulatory oversight. What once existed as a strictly administrative process is now evolving into something far