A few days ago, the Department of Justice (DOJ) released information about individual indicted for health care fraud and one interesting case involved hyperbaric oxygen therapy. Yvoune Kara Petrie of Leesburg, Virginia was charged with health care fraud in connection...
The proposed rule for Hospital Outpatient Prospective Payment System (HOPPS) has been posted. Like all of the proposed payment policies, it’s massive and you need to read it yourself. CMS is proposing to “unbundle” “skin-substitutes” in the hospital outpatient...
Well-intended overinterpretation or misinterpretation of regulatory requirements can increase workload, lead to “over-documentation,” and contribute to clinician and staff burnout. As the Chief Medical Officer of Intellicure, for 25 years I have had to deal with...
CMS has released the proposed CY 2026 Physician Fee Schedule. CMS is proposing to continue to pay for CTPs that have a biologic license agreement (BLA) using Average Sales Price (ASP) +6%. However, all other products would be paid at $125.38/cm2 (prior to the...
CMS says scammers are sending Medicare providers and suppliers phishing fax requests for medical records and documentation, falsely claiming to be part of a Medicare audit. This notice was posted on the CMS website: “CMS has identified a fraud scheme targeting...
