Today, healthcare providers face more regulations than ever. One particular form of regulation that has become more common in the past decade are Zone Program Integrity Contractor (ZPIC) audits.
These audits were designed to enforce Medicare regulations and deter improper billing practices. They can lead to allegations of fraud which may bring a healthcare organization civil or criminal charges.
Whether due to a hostile attitude, refusal to follow medical advice, anger over a diagnosis or more, many doctors, nurses and other health care professionals have encountered difficult patients at some point. Dealing with these individuals can be complicated, especially when you fear that an unfounded or unreasonable complaint could jeopardize your medical license.
Managing difficult patients requires patience and a constant commitment to acting in the best interests of the patient. Because fighting to protect your license can take considerable time and resources from your Texas practice, attempt to gain control of the situation before it escalates. Here are a few tips to ease the tension:
It happens sometimes – you file a claim with Medicare and because of insufficient documentation, duplicate payments or administrative errors, you get paid too much money.
What happens next? Medicare usually asks you to pay the money back. But you do have options.
Licensed nurses rely on their accreditation for their living. If your license is revoked, Texas has a lengthy reinstatement process for you to undergo before you can work as a nurse again.
The reinstatement process includes these steps before you’re able to work as a nurse again:
Physicians rely on the trust of multiple people, including patients, employees and members of the public. Unfortunately, some unscrupulous doctors abuse this trust to commit acts of fraud. However, there is sometimes a gray area where a trustworthy physician inadvertently commits unlawful activity.
If you suspect that you or another staff member accidentally violated the law, it may be in your best interest to voluntarily self-disclose this to the Office of Inspector General. The OIG has a set of protocol to follow that physicians can follow to potentially avoid or mitigate civil or administrative penalties.
A suspension or revocation of a medical license is one of the biggest threats to a doctor, nurse or other medical professional’s career. It may seem difficult to believe, but even after spending years striving toward their goal, many individuals in the medical field let their license be snatched away.
These are among the many behaviors that can lead to a suspension or even revocation of an individual’s license. If that happens, it is vital to speak with a legal professional immediately. An experienced attorney will know how to work within the medical field and make the strongest case possible to defend a doctor or nurse’s career.
During the course of regular business, durable medical equipment (DME) providers may face audits from zone program integrity contractors (ZPICs) working under Medicare and Medicaid. These audits are meant to root out fraudulent activities. Being selected for an audit doesn’t mean your business is under suspicion, only that an impropriety has cropped up.
First, a little background. The 2003 Medicare Modernization Act created Medicare administrative contractors to oversee the plan’s administration. ZPICs were established to identify fraud, waste and abuse among Medicare Part A and Part B providers, DME prosthetics, orthotics and supplies providers, or home health and hospice providers.
In the United States, where prescription drugs are not price-regulated by one, powerful agency, such as the federal government, smaller insurance companies must negotiate with these large drug makers. What the drug makers have found is, they have the upper hand. As many of us know, any drug in the U.S. costs significantly more than the same drug elsewhere.
Nothing makes the cost of prescription drugs more real than standing in front of the pharmacist when they give you the total. For that reason, it's common that pharmacists get the blame. Until recently, pharmacists were unable to even disclose cheaper alternatives to the drugs they prescribed. That has changed thanks to the bipartisan efforts of several senators. The Patients Right to Know Drug Prices Act allows pharmacists to share pricing information with customers on employer-sponsored and health care exchange plans, without penalty.
Who doesn't like taking shortcuts. If there is a way to get from point A to point B more easily, that's a good thing, right? That might be true in on the road, but in the health care industry, taking shortcuts around regulatory obligations can lead to financial trouble. Worse, it can result in criminal charges and result in penalties that derail careers.
Few medical practitioners intentionally follow practices that trigger investigations. However, those entities that pay claims know errors happen either by accident or on purpose, and they don't have any desire to be left holding the bag if mistakes lead to overpayments. Audits are possible and those with experience in health care law know they need to be taken seriously.
National Provider Identifiers (NPI) are used to help streamline the medical billing process, and these 10-digit numbers function much like a social security number.
Unfortunately, like a social security number, a NPI is also vulnerable to theft. This is because NPI are not confidential and can be publicly accessed through National Plan and Provider Enumeration System, as well as by your employees and possibly through online attacks.
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