Kelly Simonelli

When Medicare Documentation Falls Short Healthcare Organizations Should Consider External Audits

A recent Office of Inspector General (OIG) audit highlights an important reminder for nursing homes and other healthcare providers: Medicare billing and documentation remain under close scrutiny. Even when a Medicare Administrative Contractor (MAC) has reviewed and allowed a claim, that does not necessarily mean the claim would withstand a broader audit. On July 20, 2026, the OIG released an audit of Medicare Part B services provided to skilled nursing facility (SNF) residents. The audit…

Using PEPPER to Strengthen Medicare Compliance Across Healthcare Settings: A Practical Roadmap for Providers

The return of the Program for Evaluating Payment Patterns Electronic Report (PEPPER) provides healthcare organizations with a valuable opportunity to identify potential billing, coding, utilization, and compliance risks before they become larger concerns. To help providers and healthcare professionals make the most of this resource, LW Consulting, Inc. (LWCI) has released a new whitepaper, Using PEPPER to Strengthen Medicare Compliance Across Healthcare Settings. The whitepaper explores how PEPPER data can be used to identify outliers,…

Why Reviewing the Open Payment Database Matters: A $46 Million Lesson

On August 10, 2026, the U.S. Department of Justice (DOJ) announced a pharmaceutical company that agreed to pay over $46 million to resolve criminal and civil allegations involving kickback schemes. What is a Kickback? The Centers for Medicare & Medicaid Services (CMS) defines a kickback as “the soliciting, offering, paying, or receiving of remuneration—in cash or in kind—to induce or in return for patient referrals, or for the generation of business involving any goods or…