Providence Health and Services has been hit with a lawsuit alleging the health system violated the False Claims Act by purposely upcoding Medicare to increase reimbursement. The lawsuit, filed late last [...]
A San Diego whistleblower will receive $17. 2 mil with the settlement of a 7-year-old false statements|lawsuit against Prime Healthcare Care regarding overbilling for Medicare services at California hospitals. Read [...]
Prime care Services, Inc., Prime care Foundation, Inc., and Prime care Management, Inc. (collectively Prime), and Prime’s Founder and Chief exective officer, Dr. Prem Reddy, have united to pay the u. s. $65 million to settle allegations that fourteen Prime hospitals in Calif. wittingly submitted false [...]
You don’t have to be a coder to realize what the financial impact of proposed changes from the Centers for Medicare & Medicaid Services (CMS) will be, or to see [...]
The owner and managers of Arrow-Med Ambulance, Inc. plead guilty in connection with claims of fraud to Medicare and Medicaid. The accusation was of them using ambulances for medically unnecessary [...]
The Inspector General of the Department of Health and Human Services fined eClinicalWorks $132K for violating a 2017 agreement which had required them to report patient safety issues with its EHR [...]
The Office of Inspector General (OIG) reviewed 191,118 Medicare paid distant-site telehealth claims, totaling $13.8 million, that lacked corresponding originating-site claims. The watchdog agency then reviewed provider supporting documentation of these claims to determine if the services met Medicare’s [...]
Scholastic and country healing centers will probably observe a cut in Medicare subsidizing if the CMS concludes a proposition to diminish repayment for more-complex patients, as indicated by a Moody's [...]
According to CMS, Evaluation and management (E/M) codes are the most frequently reported—and the most audited. In a study referred to by CMS, the OIG noted that 42% of claims for E/M services [...]
The MAG (Medical Association of Georgia), alongside the American College of Emergency Physicians, sued Anthem for payment denial of some emergency department services. Read full story here!
