About Christian Roule

Christian works as the Site Administrator and Content Copywriter for The Coding Network. He is a published author and a member of the IT Team.

Florida Physicians and Practice Settle False and Fraudulent Claims Case

By |2019-06-18T03:12:03+00:00June 18th, 2019|Medical Coding News and Recent Articles|

Jaime L. Sepulveda, MD, LLC (d/b/a Miami Urogynecology Center), Jaime L. Sepulveda, M.D., and Sujata Yavagal, M.D. (collectively, "Miami Urogynecology Center"), South Miami, Florida, entered into a $173,768.08 settlement agreement with OIG. The settlement agreement resolves allegations that Miami Urogynecology Center submitted claims to Medicare for items or services that it knew or should have [...]

Comments Off on Florida Physicians and Practice Settle False and Fraudulent Claims Case

Connecticut Diagnostic Services Provider Settles Case Involving False Claims

By |2019-06-13T22:42:17+00:00June 14th, 2019|Medical Coding News and Recent Articles|

On November 19, 2018, Southern Connecticut Vascular Center, LLC (SCVC), Stratford, Connecticut, entered into a $792,076.76 settlement agreement with OIG. The settlement agreement resolves allegations that SCVC submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 96965 when those claims were for a procedure that was already included as a component of the duplex ultrasound [...]

Comments Off on Connecticut Diagnostic Services Provider Settles Case Involving False Claims

California Physician and Practice Settle Case Involving False Claims

By |2019-06-13T22:41:22+00:00June 14th, 2019|Medical Coding News and Recent Articles|

On December 20, 2018, Michael Jadali, D.O., and the Center for Pain & Rehabilitation Medicine (collectively, "Dr. Jadali"), San Jose, California, entered into a $60,406.30 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Jadali submitted claims to Medicare for Healthcare Common Procedure Coding System codes 80500 (clinical pathology consultation; limited, without review of [...]

Comments Off on California Physician and Practice Settle Case Involving False Claims

California Physician and Practice Settle False and Fraudulent Claims Case

By |2019-06-13T16:14:32+00:00June 13th, 2019|Medical Coding News and Recent Articles|

On April 12, 2019, Complete Women Care, Inc., and Miriam Mackovic-Basic, M.D. (collectively, "CWC"), with multiple locations in Los Angeles County, California, entered into a $258,045 settlement agreement with OIG. The settlement agreement resolves allegations that CWC submitted claims to Medicare for items or services that it knew or should have known were not provided as [...]

Comments Off on California Physician and Practice Settle False and Fraudulent Claims Case

Los Angeles Dental Practitioner Sentenced to Forty Months in Jail for Role in $3.8 Million Health Care Fraud Scheme

By |2019-06-12T17:37:04+00:00June 12th, 2019|Medical Coding News and Recent Articles|

A LA, California-based dental practitioner was sentenced to forty months in jail last week for his role during a $3.8 million health care fraud scheme during which he charged various dental insurance carriers for crowns and fillings that were not ever actually provided to patients. Assistant Attorney General Brian A. Benczkowski of the Justice Department’s [...]

Comments Off on Los Angeles Dental Practitioner Sentenced to Forty Months in Jail for Role in $3.8 Million Health Care Fraud Scheme

Medicare Advantage Provider To Pay $30 Million To Settle Alleged Overpayment Of Medicare Advantage Funds

By |2019-06-04T20:45:42+00:00June 4th, 2019|Medical Coding News and Recent Articles|

Sutter Health LLC, a California-based healthcare services provider, and several affiliated entities, Sutter East Bay Medical Foundation, Sutter Pacific Medical Foundation, Sutter Gould Medical Foundation, and Sutter Medical Foundation, have agreed to pay $30 million to resolve allegations that the affiliated entities submitted inaccurate information about the health status of beneficiaries enrolled in Medicare Advantage [...]

Comments Off on Medicare Advantage Provider To Pay $30 Million To Settle Alleged Overpayment Of Medicare Advantage Funds

HHS Looking Forward to Almost $3.5 Billion in Fiscal Recoveries for 2018

By |2019-05-31T17:42:55+00:00May 31st, 2019|Medical Coding News and Recent Articles|

The U.S. Department of Health and Human Services (HHS) workplace of inspector general (OIG) is within the business of finding out “fraud, waste, and abuse” within the nation’s health care system, to echo the oft-repeated phrase it uses to explain its mission. And business is booming. The Office of Inspector General is anticipating $2.9 billion [...]

Comments Off on HHS Looking Forward to Almost $3.5 Billion in Fiscal Recoveries for 2018

Baton Rouge Physician sentenced to over three years in jail in a fraud scheme

By |2019-05-28T16:03:49+00:00May 28th, 2019|Medical Coding News and Recent Articles|

A former owner and medical director of a Baton Rouge pain management clinic was sentenced to over 3 years in federal jail Friday during a health care fraud scheme, federal authorities mentioned. Dr. John Eastham Clark, who co-owned Louisiana Spine & Sports on Bluebonnet avenue, additionally was ordered to pay nearly $255,000 in restitution by [...]

Comments Off on Baton Rouge Physician sentenced to over three years in jail in a fraud scheme

Company Carolina Physical Therapy Will Pay almost $800K to Settle False Billing Allegations

By |2019-05-22T11:19:16+00:00May 22nd, 2019|Medical Coding News and Recent Articles|

US Attorney Sherri A. Lydon made the announcement that the US Attorney’s Office for South Carolina has settled numerous claims of prolific health care fraud with Carolina Physical Therapy (also called “Carolina PT” for short).  The company in question was a chain of nearly ten physical therapy practices headquartered in and around Columbia, Irmo, Lexington, [...]

Comments Off on Company Carolina Physical Therapy Will Pay almost $800K to Settle False Billing Allegations

These ten doctor specialties generate the foremost revenue for hospitals

By |2019-05-16T18:20:26+00:00May 16th, 2019|Medical Coding News and Recent Articles|

The amount of revenue physicians generate for hospitals is usually significantly over their annual salaries, in keeping with a recent survey by medical practitioner staffing firm Merritt Hawkins. The survey was emailed to roughly three thousand hospital CFOs and different money managers across the state between Oct 2018 and Dec 2018, and therefore the survey results embrace information on ninety-three hospitals. Despite [...]

Comments Off on These ten doctor specialties generate the foremost revenue for hospitals