Coding Compliance Risk

HCC Coding Compliance: Avoid Revenue Loss and Fines in Healthcare

By |2024-01-26T02:46:23+00:00January 12th, 2024|

Navigating the complex labyrinth of HCC coding is a daunting task for healthcare providers due to the frequent carrier changes to rules and regulations, and non-compliance could mean substantial revenue [...]

DOJ alleges Kaiser Permanente defrauded Medicare of $1 billion

By |2021-11-02T03:41:19+00:00November 2nd, 2021|

Kaiser Permanente and members of its healthcare consortium defrauded Medicare of nearly $1 billion by tacking on diagnoses to patients’ medical records to earn more in reimbursement payments, the Department [...]

Split Model Service Providers (Medical Coding Vendors with Offshore and Onshore Operations)

By |2020-05-28T18:31:39+00:00May 21st, 2020|

A troubling trend in the medical coding industry is a misleading split model where companies will have resources both onshore and abroad but not disclose which personnel are performing the [...]

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

By |2020-04-14T04:58:22+00:00February 1st, 2020|

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 [...]

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

By |2020-04-14T04:59:10+00:00February 1st, 2020|

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 [...]

Office Manager and Wife of Conway Arkansas Doctor Arrested for Medicaid Fraud

By |2020-04-14T05:00:42+00:00November 27th, 2019|

Leslie Rutledge, an Attorney General for the State of Arkansas, announced today that a Conway Optometrist's Officer Manager had been arrested and charged with for defrauding almost $600K from the [...]

Lenox Hill Hospital Pays $12.3 Million Settlement For Submitting Fraudulent Medicare Claims

By |2020-04-14T05:01:35+00:00November 25th, 2019|

The US Attorney for Manhattan, New York, and a Special Agent for the OIG's New York Regional Office, announced today that the US Federal Government has settled a civil fraud [...]