The Trouble with RACs

It seems the United States House of Representatives has taken aim at Medicare Recovery Audit Contractors (“RACs”). The RACs are private, non-governmental entities that are authorized by the Medicare program to conduct audits of Medicare providers and suppliers. In December, 2013, the Office of Medicaid Hearings and Appeals (“OMHA”) sent a letter to providers with […]

Attention OPWDD Providers: OMIG Releases Compliance Guidance for Corporate Compliance Programs

The New York State Office of the Medicaid Inspector General (OMIG) has released Compliance Guidance for use by providers regulated by the New York State Office of Persons for Developmental Disabilities (OPWDD). The routine identification of compliance risk areas, relating to the particular type of services being offered by Medicaid providers, is required for certain […]

False Claims Act: Payment vs. Participation Regulations

In U.S. ex rel. Williams v. Renal Care Group, Inc. (Case No. 11-5779) (October 5, 2012), the Sixth Circuit Court of Appeals reversed a grant of summary judgment in favor of the United States on two main False Claims Act (FCA) claims relating to Medicare reimbursement of dialysis supplies. In doing so, the Court issued […]