Overpayment Audit: Medicaid is Serious About Excluded Providers

Under the Affordable Care Act (ACA), providers and suppliers who bill for services furnished by an excluded or an unlicensed person are considered to have received and overpayment from Medicare which must be reported and returned within 60 days of “identifying” the overpayment (claims-based overpayment). New Jersey Medicaid recently reminded providers that a similar requirement for Medicaid and Medicaid Managed Care providers exists in New Jersey and will be enforced.

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Medicare Enrollment Screening Tools Reviewed By OIG

The Centers for Medicare & Medicaid Services (CMS) views the enrollment process as an important gatekeeping tool for preventing fraud, waste and abuse. The passage of the Affordable Care Act (ACA) enhanced the ability of CMS to further this goal. Recently, the Office of the Inspector General (OIG) published a report analyzing the effectiveness of certain enhanced provider enrollment screenings.

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Healthcare Providers Beware: Failure to Pay State Tax Could Lead to License Suspension

On May 16, 2016, a new rule went into effect that empowers the New Jersey Division of Taxation Director to notify a licensing State agency that a license issued by the agency to conduct a profession, trade, business, or occupation should be suspended where a license holder fails to pay a State tax indebtedness.

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Medical License and the Importance of Infection Control

A recent decision from the New Jersey Appellate Division serves as reminder of the importance of maintaining effective infection control measures in a provider’s office or face the harsh consequences of the licensing board.

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Domino Effect of Professional Disciplinary Action

When a healthcare professional faces professional discipline the initial focus tends to be on getting through and beyond the proceeding. Healthcare professionals, however, should also be aware of the collateral consequences that may stem from a professional disciplinary action.

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