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Beware of Phony TMB, DEA Agents and Other Scams - 11/15/2022

The Texas Medical Board (TMB) is warning physicians and pharmacies of a scam involving criminals who sometimes pose as TMB officials. TMB passed along a report from the U.S. Drug Enforcement Administration (DEA) that says physicians registered with the DEA are receiving calls and emails from criminals who identify themselves as DEA personnel or other law enforcement agents.

Stark Self-Referral Laws and Regulations - 10/07/2022

Stark generally prohibits a physician (or an immediate family member of such physician) who has a direct or indirect financial relationship with an entity that provides a designated health service from making a referral for that service for which Medicare or Medicaid would otherwise pay. This very broad prohibition is mitigated by a large number of exceptions. These exceptions must be met exactly. Failure to meet a Stark exception will result in a violation.

UnitedHealthcare Eliminates Copay Costs on Insulin, Other Life-Saving Medications - 08/05/2022

Some patients struggling with the cost of medications like insulin and epinephrine just got a small-but-important break from one of the nation’s largest health insurers.

Beware Third Party Scams - 12/21/2021

As technological capabilities have evolved, some individuals and organizations are using these capabilities to try to scam others out of their private personal or payment information.

Data Driven: Medicaid’s Inspector General Focuses on Fraud Prevention, Not Just Prosecution - 09/06/2021

Since her appointment in 2018, Texas Health and Human Services Inspector General Sylvia Hernandez Kauffman has homed in on using data analytics not only to prosecute fraud, waste, and abuse within the Medicaid program, but also to prevent it from happening in the first place. Texas Medicine spoke to Ms. Kauffman about what appears to be a shift in tone from this department as it also focuses on using the data it collects to educate physicians and other health care professionals on common billing mistakes.

What Triggers a Coding Audit? - 08/20/2021

What Triggers a Coding Audit?

United Walks Back Payment Cut on Nonphysician Billing - 08/05/2021

Following strong pushback from the Texas Medical Association, UnitedHealthcare (UHC) has effectively reversed its payment-cutting policy change on “incident-to” billing for services performed by nonphysician practitioners (NPPs). 

UnitedHealthcare Waives Cost Sharing, Extends Telemedicine for Certain Plans - 06/16/2021

UnitedHealthcare is waiving cost sharing for Medicare Advantage plan members for primary care services, and has extended access to in-network and out-of-network telemedicine visits, including COVID-19 testing and treatment, until Dec. 31 for most of its plans.

Did You Subscribe to UHC’s Premium Payment Program? Check By March 31 - 03/29/2021

TMA reminds practices that now is a good time to determine whether you are enrolled in UnitedHealthcare’s (UHC) Optum Pay Premium program, which charges a fee for access to certain electronic data. Physicians and practices who wish to opt out of the program should do so by March 31.

UHC Postpones Higher Liability Coverage Requirements Plan - 12/11/2020

UnitedHealthCare (UHC) postponed a plan that would require Texas physicians to substantially increase their professional liability insurance coverage in order to participate in its networks. The move comes after the Harris County Medical Society and Texas Medical Association expressed serious concerns about the new policy.

Revised UnitedHealthcare E&M, Prior Auth Procedures to Take Effect Jan. 1 - 12/09/2020

The Texas Medical Association’s reimbursement specialists want to be sure you see the following items in the UnitedHealthcare (UHC) December bulletin.

Collecting Payment for Noncovered Services - 10/15/2020

Can you charge a patient for a service the patient’s health insurance plan doesn’t cover? Answer: It depends.

Watch Out For COVID-19 Cyber Scams - 03/20/2020

Internet scammers are trying to cash in on the widespread anxiety over COVID-19, and awareness is the best defense, according to the U.S. Cybersecurity and Infrastructure Security Agency. Likewise, the Texas Attorney General's Office has issued a warning about outbreak-related scams.

UnitedHealthcare Out-of-Network Referrals: Prior Approval, Patient Consent - 02/05/2020

If you are a UnitedHealthcare (UHC) participating physician referring a patient out of network in a nonemergency, you’re now required to first obtain either (1) prior approval from UHC; or (2) the patient’s written consent.

Microsoft Windows, Server Systems Vulnerable to Hackers, Feds Warn - 01/17/2020

Texas physicians should look out for a security weakness in Microsoft Windows 10, Server 2016, and Server 2019, the Department of Homeland Security (DHS) said this week.

Ousting the ‘F-Word’ From Your Practice - 10/29/2019

You do everything you can to keep your patients safe and healthy. But are you sure your practice is safe from fraud and abuse? Don’t wait for a costly government audit – or a criminal charge – to come knocking. Check out the Texas Medical Association’s e-book, Fraud and Abuse Prevention Simplified, which can help you learn to protect both your practice and patients.

Medical Devices Could Be Vulnerable to Hackers, FDA Warns - 10/02/2019

Certain medical devices and hospital communications networks could contain cybersecurity vulnerabilities that could allow a remote attacker to take control of the device and change its function, the Food and Drug Administration (FDA) warned on Tuesday.

United Healthcare Cuts Consults - 09/04/2019

United Healthcare is eliminating payment for consults in two phases – one that took effect June 1 for certain services, and their complete elimination starting in October. The change is an effort to align with the Centers for Medicare & Medicaid Services policy that eliminated payment for most consults in 2010, but it’s going to make it more difficult for many specialists to get compensated for the extra time and work those services require.

Beware of Scam Email Sent to TMA Members - 08/21/2019

An unauthorized email that claimed to be from the Texas Medical Association recently was sent to some TMA members stating that the individual member’s dues statement and insurance policy update was included. If you received this email, please know that it did not originate from nor was it authorized by TMA or the TMA Insurance Trust, and you should discard it.

Scammers Targeting Texas Pulmonologists Seeking $500 - 06/19/2019

The Texas Medical Association is warning pulmonary physicians to be aware of a scam involving a letter from a phony medical board that seeks $500 “for Pulmonary Disease Certification Status Verification.” Two Texas pulmonologists contacted TMA to report a letter from the “American Board of Pulmonary Disease” notifying them of a “very important requirement to continue certification in pulmonary disease at this time. You are on record having failed to previously register, and must comply.”

Alert: Scammers Demanding Bogus Fines For Drug Purchases - 04/01/2019

The Texas Medical Association and the Texas Medical Liability Trust (TMLT) are warning physicians about scammers posing as a U.S. Drug Enforcement Administration agent trying to defraud doctors into paying a nonexistent federal fine for allegedly intercepting illegal prescription drugs the doctor had sent through the mail.

Greenway Clients Entitled to Free EHR Upgrade After Fraud Settlement - 02/12/2019

Electronic Health Record vendor Greenway Health has been ordered to offer its clients free upgrades to its latest version of Prime Suite as part of a settlement in a multimillion-dollar fraud case.  

New UnitedHealthcare Automated Services Can Save You Time - 11/13/2018

UnitedHealthcare says it has made it easier for you to submit records, have claims paid sooner, and access pharmacy benefit information.

Don’t Fall for Credentialing Scam, Blue Cross Says - 10/23/2018

Blue Cross and Blue Shield of Texas warns physicians to be aware of a scammer that is offering to help doctors become credentialed with the insurance company for $250.

United to Add Lab, Change Lab and Other Policies - 10/04/2018

Starting Jan. 1, 2019, UnitedHealthcare will use Quest Diagnostics, in addition to LabCorp, as in-network laboratories for all UHC members (excluding existing lab capitation agreements).