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How CGX Laboratories Can Be Compliant

Medicare began providing coverage for genetic cancer screening (CGX) in 2018. While this was a positive development for testing laboratories, some labs that have been billing Medicare for CGX have run into compliance issues. If your testing laboratory bills Medicare for CGX, this article provides an overview of what you...

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Alzheimer’s Testing Compliance

According to the National Institutes of Health (NIH), it is estimated that more than 5.5 million Americans may suffer from Alzheimer’s disease. Among other things, this means that diagnosing and treating seniors with Alzheimer’s disease presents a significant opportunity for neurologists, psychiatrists, geriatricians, and other health care providers to help...

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Continuous Glucose Monitoring (CGM) Medicare Compliance

In 2018, the Centers for Medicare and Medicaid Services (CMS) expanded Medicare coverage for continuous glucose monitoring (CGM). While this is good news for program beneficiaries who need CGM, billing compliance has proven to be a challenge for many pharmacies and other health care providers. When continuous glucose monitoring (CGM)...

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Federal CGX and PGX Investigations

Oberheiden P.C. Represents Laboratories, Distributors, and Business Owners in CGX and PGX Investigations Nationwide Are you worried about current PGX and CGX investigations? Did one of your former business partners get raided or indicted? Did the FBI or agents from the Office of Inspector General (OIG) stop by to interview...

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Penalties in Home Health Medicare Fraud

Medicare Fraud Defense Attorneys Available Now Everyone knows how dangerous it is to mess with Medicare billing. Few, however, are aware what actual penalties and consequences Medicare fraud allegations can trigger. Of all industries, owners of home health care centers are disproportionately high exposed to audits, investigations, and even criminal...

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Is It Legal to Purchase Medicare Leads?

This summary, co-written by former DOJ healthcare fraud prosecutors, attempts to answer a question of increasing importance: under what circumstances is it legal to purchase patient leads? What is the difference between a raw and a qualified lead—and why does it matter? What is the Justice Department’s position on the...

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The Growing Threat of Zone Program Integrity Contractor (ZPIC) Audits

Health care providers face immense scrutiny for allegations of fraud and abuse in the current regulatory climate. Consequently, they encounter significant threats to their future business viability, including recoupment and civil/criminal penalties, when undergoing audits conducted by the federal government. It is essential that you as a healthcare provider, servicing...

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Hyperbaric Oxygen Therapy Fraud Investigations

Federal Prosecutors Have Raided Medicaid and Medicare Providers for Alleged Fraud in Connection with Oxygen Therapy Devices Medicare and Medicaid reimburse well for hyperbaric oxygen therapy devices and several business owners and providers have promoted the idea to beneficiaries. Unfortunately, however, the dispensing of oxygen devices is a decision of...

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What Cardiologists Should Know About Medicare Fraud Prosecutions

CMS & FBI Targets Cardiologists for Stress Tests, Opioid Abuse, and Billing Fraud. Prosecutions Nationwide. Are you a cardiologist? Is your business under audit? Did a patient threaten to complain against you? Did you receive a ZPIC audit request? Are you consider an "outlier?" Have you received notice from the...

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When Can a Mobile Ambulance Ride Lead to Charges for Medicare Fraud?

Medicare's Strict Billing Rules for Mobile Ambulance Services Create Significant Risks for EMS Providers Emergency medical services (EMS) providers serve a critical role in our health care system. However, like all health care providers that bill Medicare for their services, they are subject to strict billing rules and regulations, and...

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