About George Grant

This author has not yet filled in any details.
So far has created 13 blog entries.

Medicare Advantage Organization and Former COO to Pay $32.5 Million to Settle False Claims Act Allegations

By |June 2nd, 2017|

Freedom Health Inc., a Tampa, Florida-based provider of managed care services, and its related corporate entities (collectively “Freedom Health”), agreed to pay $31,695,593 to resolve allegations that they violated the False Claims Act by engaging in illegal schemes to maximize their payment from the government in connection with their Medicare Advantage plans, the Justice Department […]

Comments Off on Medicare Advantage Organization and Former COO to Pay $32.5 Million to Settle False Claims Act Allegations

OIG Posts a Resource Compliance Guide & Enforcement Action

By |March 29th, 2017|

You can use the links provided and go directly to the OIG material.

The OIG has developed free educational resources listed are to help health care providers, practitioners, and suppliers understand the health care fraud and abuse laws and the consequences of violating them. These compliance education materials can also provide ideas for ways […]

Comments Off on OIG Posts a Resource Compliance Guide & Enforcement Action

Medical Billing Codes Key to Fraud Case Against 2 Erie Oral Surgeons

By |August 8th, 2016|

John F. Lehrian, who is retired, and David E. Palo, of what was known as Lehrian & Palo Oral Surgery, 100 State St., pleaded not guilty to federal charges that they the defrauded insurance companies of more than $323,000. They were indicted July 12 on charges of health care fraud. The government is alleging Lehrian […]

Comments Off on Medical Billing Codes Key to Fraud Case Against 2 Erie Oral Surgeons

Dermatology Physicians / Practice to Pay $1.9 Million to Settle Overbilling Medicare for E&M Services

By |April 21st, 2016|

Abusers of the Medicare system can sometimes be intentional or not, but the stories that really get significant attention of the public are the ones that highlight healthcare personnel that intentionally over bill Medicare.

There are several types of abuse including falsifying claim forms adjusting the actual cost of services, Billing for services and supplies that […]

Comments Off on Dermatology Physicians / Practice to Pay $1.9 Million to Settle Overbilling Medicare for E&M Services

$750,000 HIPAA SETTLEMENT CAUSES OCR TO UNDERSCORE NEED FOR ORGANIZATION WIDE RISK ANALYSIS

By |December 18th, 2015|

In a $750,000 HIPAA Settlement, the University of Washington Medicine (UWM) has agreed to settle charges that it potentially violated the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Security Rule by failing to implement policies and procedures to prevent, detect, contain, and correct security violations.  UWM is an affiliated covered entity, which includes designated […]

Comments Off on $750,000 HIPAA SETTLEMENT CAUSES OCR TO UNDERSCORE NEED FOR ORGANIZATION WIDE RISK ANALYSIS

Final 2016 Medicare Physician Fee Schedule Released

By |November 7th, 2015|

The MGMA reports that the final 2016 Medicare physician fee schedule has been released.

The Centers for Medicare & Medicaid Services (CMS) finalized the Medicare physician fee schedule (PFS) for 2016.

Key policies finalized in the 2016 payment rules include:

Finalizing the Home Health Value-Based Purchasing model.
Finalizing updates to the “Two-Midnight” rule.
Finalizing the End-Stage Renal Disease Quality Incentive […]

Comments Off on Final 2016 Medicare Physician Fee Schedule Released

ICD-10 Aftershocks: The Challenges Every CFO Can Expect

By |October 28th, 2015|

If any individual in the C-suite will feel the effects of ICD-10 most prominently, it will be the hospital CFO. As reported in Becker’s Hospital Review, October 2015, in a article by Kelly Whittle, MS, Principal, ICD-1 0 Advisory and Whittle Advisors, LLC, the top 4 issues faced by hospital CFO will include.

Significant productivity loss […]

Comments Off on ICD-10 Aftershocks: The Challenges Every CFO Can Expect

Medicare Reimbursement Rates Get a Small Increase

By |July 16th, 2015|

California Medical Association (CMA ALERT) – The CMS announced that a 0.5% increase will be made for Medicare reimbursement rates, which are effective starting July 1, 2015 to December 31, 2015.

The increase to Medicare reimbursement rates is an effect of the Medicare Access and CHIP Reauthorization Act, signed in April 2015. CMS has released the […]

CMS will reimburse ICD-10 mistakes for one year after transition deadline

By |July 7th, 2015|

For one year past the Oct. 1, 2015 deadline, the CMS will reimburse for wrongly coded claims as long as that erroneous code is in the same broad family as the right one. There had been concerns among providers that they wouldn’t be paid if they made minor mistakes trying to implement the new complex […]

US Attorney’s Office Recovers Over $20 Million Dollars Against Community Health Network

By |July 2nd, 2015|

In another instance of false claims to Medicare and Medicaid programs, Josh J. Minkler, United States Attorney, announced today a $20,324,902.22 civil settlement with Community Health Network (ACHN), a non-profit health system with more than 200 sites of care and affiliates throughout the State of Indiana.

You can read the full article on the justice.gov website here […]