CASE STUDY OF PROFESSIONAL BOARD DISCIPLINARY ACTIONS
This case study includes a combination of different scenarios and outcomes based on our experiences over the years, and is […]
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Navigating Regulatory Compliance for Healthcare Providers
Navigating healthcare regulations in New Jersey and New York is crucial for avoiding severe sanctions and liabilities. Healthcare providers must comply with laws like HIPAA, Stark Law, and Anti-Kickback Statute, along with Medicare and Medicaid regulations. Inadequate compliance can lead to allegations of fraud and threaten a provider’s license. To mitigate these risks, providers should maintain robust compliance programs, including accurate record-keeping, proper billing practices, and regular self-audits. At Garcia-Watts Law, LLC, we specialize in helping healthcare providers establish and maintain compliance, ensuring they can focus on patient care without the burden of regulatory complexities.
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Navigating Payor Claw-Backs: An Overview for Healthcare Providers and Entities
Navigating payor demands is daunting, especially when claw-backs are involved. Claw-backs are when a payor demands that a provider return payments for previously paid claims. These demands are routinely based on allegations of, among other things, non-covered services, lack of medical necessity, insufficient documentation, improper coding, uncollected patient responsibilities, or even fraud.
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