AMARILLO, TX – The following is Part Three of a three part series addressing exclusion from federal health care programs. Part One addressed the OIG’s exclusion authority. Part Two addressed the procedure that the OIG follows in excluding an

AMARILLO, TX – As all of us are aware, Medicare Part B covers DME furnished to a Medicare beneficiary who is residing in his “home.” Generally speaking, a beneficiary that receives inpatient “rehab” services in a skilled nursing facilit

AMARILLO, TX – The DME industry is young and grew up relatively unregulated. As concerns over overutilization, fraud, and the rising costs of health care have increased, so has scrutiny from the federal government. One of the biggest challenges

AMARILLO, TX – Health care in the United States is good, but it is inefficient. Payment methodology has historically been based on a fee-for-service (“FFS”) model. This means that the payor pays for the service rendered, or the prod

AMARILLO, TX – 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 conduct

AMARILLO, TX – Assume that ABC Medical Equipment, Inc. is a Medicare-enrolled DME supplier and that XYZ Retail Sales, Inc. (a separate legal entity) is a cash-only business. Assume that ABC and XYZ have identical ownership. Lastly, assume that