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About Christian Roule

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So far has created 60 blog entries.

Under Michigan’s New Medicare RAC Regime, Physician Services Are the Initial Primary Target

By |September 5th, 2017|

An announcement came back in back in October 2016 from the Centers for Medicare & Medicaid Services (CMS). It announced that it had awarded to various entities the next round of contracts to serve as Recovery Audit Contractors (RACs) for their Medicare program. In totality, five separate RAC contractors were awarded. Each one was connected […]

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Civil Fraud Case Settlement from Fredericksburg Hospitalist Group amounts to $4.2 Million

By |September 1st, 2017|

Along with 14 of its member shareholders, Fredericksburg Hospitalist Group has agreed to pay nearly $4.2 million to settle a federal False Claims Act case brought under the qui tam whistleblower provisions of the FCA.

Read the full story here!

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Medical Practice Agrees To Resolve Allegations Of Overbilling Medicare

By |August 28th, 2017|

St. Agnes Healthcare in Baltimore, Maryland has agreed to pay the United States a sum of $122,928 to resolve issues under the False Claims Act. These allegations allege that they submitted false claims to Medicare by billing for E&M Services at a higher reimbursement rate than the Federal health care programs allowed.

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Due to Improper Billing, Healey Returns $500,000 in Settlement With a Springfield Dentist

By |August 25th, 2017|

Massachusetts Attorney General Maura Healey announced today a settlement with a pediatric dentist in Springfield. Healey’s office returned $500,000 to MassHealth, the state’s Medicaid program, resolving claims that improper billing for services occurred.

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Hospital in Macon will pay $2.5 million to settle billing allegations

By |August 7th, 2017|

The Navicent Health Medical Center has agreed to pay $2.5 million to settle federal allegations that it submitted bills for ambulance trips that were either medically unnecessary or inflated. The settlement follows a 27-month investigation, which was prompted by a whistleblower.

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Carolina Healthcare System Agrees To Pay $6.5 Million

By |July 6th, 2017|

The Charlotte-Mecklenburg Hospital Authority, dba Carolinas Healthcare System (CHS), has agreed pay the Government $6.5 million according to U.S. Attorney Jill Westmoreland Rose. This was to resolve allegations that the company violated the False Claims Act, by “up-coding” claims for urine drug tests in order to receive higher payment than allowed for the tests. The settlement […]

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Norman Orthopedic Practice Pays $1,537,796

By |June 28th, 2017|

Orthopedic and Sports Medicine Center-Norman (collectively “OSC”) have paid $1,537,796 to settle civil claims stemming from allegations that they submitted false claims to Medicare, Medicaid, the Department of Veterans Affairs, and TRICARE. In reaching this settlement, OSC did not admit liability, and the government did not make any concessions regarding the legitimacy of the claims. The agreement […]

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Richmond Hospitalist Group Settles Federal FCA Case

By |June 19th, 2017|

Fredericksburg Hospitalist Group, located in Richmond, VA, and fourteen of its member shareholders have agreed to pay nearly $4.2 million to settle a federal FCA case brought under the “qui tam whistleblower” provisions. Dana J. Boente, U.S. Attorney for the Eastern District of Virgini, said, “Rooting out fraudulent billing by healthcare providers is a priority. This […]

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Medicare overbilled by $41.9M – Mount Sinai Hospital

By |May 15th, 2017|

New York City: According to a recent OIG report, Mount Sinai Hospital failed to comply with Medicare’s billing requirements for 110 outpatient and inpatient claims reviewed by the office of Inspector General for the audit period of January 1st, 2012, through December 31st, 2013.

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Dermatologist in Encino to Pay $2.7 Million

By |April 26th, 2017|

Dr. Norman A. Brooks, M.D., the owner of The Skin Cancer Medical Center in Encino, has paid the United States nearly $2.7 million on April 10th to resolve allegations that he submitted bills to Medicare for Mohs micrographic surgeries for skin cancers that were medically unnecessary.

Read the Full Article here.

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