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Targeted Probe and Educate – A Step in the Right Direction

By: Denise M. Leard, Esq. In recent years, CMS has shifted its audit strategy. It has moved from a pay and chase model to a model in which it does not let the money out the door. In doing so, it has greatly increased the number of prepay audits it conducts. While a prepayment audit […] More...

4 Benefits Of Hiring A Business Attorney

Owning or starting a business can be difficult, especially if you do not have an attorney to help you navigate the process. Some of the questions business owners may have include those pertaining to legal matters. All business owners must understand what laws concern their company and what to do in case litigation is brought […] More...

FAQs About Patients Paying Cash For DME

Suppliers with insurance contracts need to understand how those contracts impact cash sale transactions. To help suppliers avoid legal landmines while navigating the DME cash-pay landscape, health law attorneys Jeffrey Baird and Lisa Smith presented a free webinar on August 2, 2017. Set out below are select questions and Brown & Fortunato’s answers, as well […] More...

Competitive Bidding Round 2019

By: Jeffrey S. Baird, Esq. On January 31, 2017, CMS announced plans to consolidate all rounds and areas included in the Competitive Bidding Program (“Program”) into a single round of competition – Round 2019. After the current Round 1 2017, Round 2 Recompete, and National Mail-Order competition conclude on December 31, 2018, Round 2019 contracts […] More...

Accountable Care Organizations: From Basics to the Next Generation

By: Rossanna J. Madrigal, Esq. The term Accountable Care Organizations (“ACOs”) was formally defined by the Affordable Care Act (“ACA”) in 2010. ACOs are defined as “a legal entity that is recognized and authorized under applicable State, Federal, or Tribal law, is identified by a Taxpayer Identification Number (TIN), and is formed by one or […] More...

Failure to Repay Medicare: Effect on Affiliated Company

By: Jeffrey S. Baird, Esq. Assume that ABC Medical Equipment, Inc. (“ABC”) is 100% owned by John Smith. Assume that Smith also owns 50% of XYZ Medical Equipment, Inc. (“XYZ”) and 25% of DEF Medical Equipment, Inc. (“DEF”). Lastly, assume that, pursuant to a series of aggressive audits, ABC gets hit with recoupment demands that […] More...

Hospital Loan Closet: Legal Basis to Bill Part B

By: Jeffrey S. Baird, Esq. It is a common practice for a DME supplier to enter into a loan closet arrangement with a hospital. This is also known as a “consignment” or “stock and bill” arrangement. In a typical loan closet arrangement, the supplier stores inventory (e.g., canes, walkers, braces) at the hospital. When a […] More...

Utilization of a Marketing Company: Kickback Risks

By: Jeffrey S. Baird, Esq. In the real world, it is common for a business (auto parts supplier, widget company) to “outsource” marketing to a marketing company. The marketing company generates business for the widget company, the widget company pays commissions to the marketing company, and everybody is happy. Unfortunately, pharmacies are not in the […] More...