About George Grant

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So far George Grant has created 16 blog entries.

Texas Physician Guilty in $325M Fraud Case Involving False Diagnoses

By |2020-02-01T22:24:17+00:00February 1st, 2020|Uncategorized|

A Texas physician was found guilty Jan. 15 for his role in a $325 million healthcare fraud scheme that involved falsely diagnosing patients with various degenerative diseases and then administering chemotherapy and other toxic drugs to patients based on the false diagnoses, according to the Department of Justice. After a 25-day trial, Jorge Zamora-Quezada, MD, was [...]

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Healthcare billing fraud: Five Latest Settlements – Revenue Cycle E-Newsletter

By |2020-02-01T22:09:36+00:00February 1st, 2020|Uncategorized|

Here are five healthcare organizations that entered into settlements to resolve billing fraud allegations in the past two months. You can . read the full story from Revenue Cycle E-Newsletter / Becker's Hospital Review here. 1. Wisconsin health system will pay $10M to settle whistleblower case 2. Physician group will refund Medicare $829K to resolve improper billing [...]

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Repeal of MIPS – Recommendation to Congress, MedPAC 12 to 4 Vote

By |2018-01-13T00:14:39+00:00January 13th, 2018|Medical Coding Audits and Compliance, Medical Coding News and Recent Articles|

A top Congressional advisory body has voted to recommend that Congress repeal the Merit-based Incentive Payment System (MIPS) and replace it with a simpler quality reporting system that would not be mandatory in the way that MIPS is. The 14-2 vote by members of the Medicare Payment Advisory Committee (MedPAC) was criticized by some provider [...]

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

By |2017-06-02T05:22:19+00:00June 2nd, 2017|Medical Coding Audits and Compliance, Medical Coding News and Recent Articles|

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 [...]

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OIG Posts a Resource Compliance Guide & Enforcement Action

By |2017-03-29T19:30:38+00:00March 29th, 2017|Medical Coding Audits and Compliance, Medical Coding News and Recent Articles|

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 to [...]

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

By |2016-08-08T16:46:14+00:00August 8th, 2016|Medical Coding and Billing, Medical Coding Audits and Compliance|

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 [...]

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

By |2019-04-04T00:49:54+00:00April 21st, 2016|Uncategorized|

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 [...]

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

By |2019-04-04T00:49:54+00:00December 18th, 2015|Uncategorized|

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 [...]

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Final 2016 Medicare Physician Fee Schedule Released

By |2019-04-04T00:49:54+00:00November 7th, 2015|Medical Coding and Billing, Medical Practice Revenue Optimization|

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 [...]

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ICD-10 Aftershocks: The Challenges Every CFO Can Expect

By |2015-10-28T04:38:31+00:00October 28th, 2015|ICD-10 Readiness, Medical Coding Best Practices|

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 [...]

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