As children, we say things are or are not fair. But what is fair? In law, fairness is “tried” in the courts of equity rather than law. Equitable estoppel and the defense of laches are arguments made in the courts of equity. Is it fair if you’ve been billing Medicare for services that you were told by CMS was billable and reimburse-able – for years – then, unexpectantly, CMS says, “Hey, providers, what you were…

No one is free from audits. Even auditors get audited. When the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) audits auditors, however, the auditors get recommendations for changes, not the million-dollar penalties that healthcare providers receive. In September 2020, OIG released an audit report of the Accountable Care Organizations (ACOs). There were 472 ACOs in America as of 2017, per the report. To those ACOs that were not audited…

Before the informative article below , I have two announcements! (1) My blog has been “in publication” for over eight (8) years, this September 2020. Yay! I truly hope that my articles have been educational for the thousands of readers of my blog. Thank you to everyone who follows my blog. And… (2) Knicole Emanuel and her legal team have moved law firms!!! We are now at PractUS, LLP. See the video interview of John…

Even though the public health emergency (“PHE”) for the COVID pandemic is scheduled to expire July 24, 2020, all evidence indicates that the PHE will be renewed. I cannot imagine a scenario in which the PHE is not extended, especially with the sudden uptick of COVID. Center for Medicare and Medicaid Services (CMS) has given guidance that the voluminous number of exceptions that CMS has granted during this period of the PHE may be extended…

As of now, the public health emergency (PHE) for the COVID-19 pandemic will expire July 24, 2020, unless it is renewed. Fellow contributor David Glaser and I have both reported on the potential end date of the PHE. Recent intel from Dr. Ronald Hirsh is that the Centers for Medicare & Medicaid Services (CMS) may renew the PHE period. Each time the PHE period is renewed, it is effective for another 90 days. Recent news…

Originally posted on RACMonitor. Tune in for Knicole Emanuel’s webinar on June 17, 2020, Post-Pandemic Audits. Instead of “Love in the Time of Cholera,” we are currently living through “Audits in the Time of COVID.” The period we are all still facing has been dubbed, legally, a public health emergency, or PHE (not to be confused with PPE). The Centers for Medicare & Medicaid Services (CMS) has loosely defined what a PHE is – but…

Since COVID-19, courts across the country have been closed. Judges have been relaxing at home. As an attorney, I have not been able to relax. No sunbathing for me. Work has increased since COVID-19 (me being a healthcare attorney). I never thought of myself as an essential worker. I still don’t think that I am essential. On Friday, May 8, my legal team had to appear in court. “How in the world are we going…