Coding Compliance Risk

Offshore Coding: HIPAA Risks

By |2020-05-28T18:29:52+00:00May 21st, 2020|Coding Compliance Risk, HIPAA & Remote Coding|

From a compliance exposure perspective, we believe that the HIPAA risk associated with sending PHI abroad is simply untenable.  HIPAA is an American law that does not extend beyond our borders.  The only way to ensure HIPAA protection abroad is to do so contractually via a BAA.  There is no regulatory authority abroad for the [...]

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

By |2020-05-28T18:31:39+00:00May 21st, 2020|Coding Compliance Risk, Remote Medical Coding|

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 services.  Some use their domestic resources almost exclusively for client facing interactions, such as sales and operations, but send all of the coding work to [...]

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CMS Delays New Payment Model for Emergency Care Due To Covid-19

By |2020-04-15T05:05:43+00:00April 15th, 2020|Coding Compliance Risk, COVID-19 Medical Coding|

CMS has delayed the start date of its Emergency Triage, Treat and Transport model from May 1 until this fall. CMS selected 205 participants in February for the five-year ET3 model. CMS said it is delaying the start date because participants now are focused on responding to the COVID-19 pandemic. The new model aims to give ambulance care teams [...]

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

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

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 |2020-04-14T04:59:10+00:00February 1st, 2020|Coding Compliance Risk|

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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Concern Raised Over Estimated Billions Shown in Chart Reviews

By |2020-04-14T04:59:56+00:00December 13th, 2019|Coding Compliance Risk|

The Office of the Inspector General of the United States undertook a recent study in which they reviewed a myriad of Medicare Advantage organizations (MAOs). There were concerns that these MAOs may be using chart reviews to increase the intake of their risk adjusted payments in an inappropriate manner. To those not in the know, [...]

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

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

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 Arkansas Medicaid Program during the course of a four-year period. Attorney General Rutledge went on record saying that “Medicaid funds are crucial to assist some [...]

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

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

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 suit against Lenox Hill (a Manhattan Hospital) and its corporate parent Northwell. The Government’s complaint alleges that the two Defendants violated the False Claims Act [...]

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Company Owner Goes to Jail for Medicaid Fraud

By |2020-04-14T05:02:30+00:00November 6th, 2019|Coding Compliance Risk|

The owner of a transport company has pleaded guilty to fraudulently charging the good citizens of Massachusetts millions in false claims through the state’s Health Care Program known as MassHealth. The 59 year old Michael Davini plead guilty in court at Worchester on October 24th to charges of felony larceny to amounts exceeding $250, committing [...]

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Anesthesia Place in Traverse City Will Now Pay $600K For Falsifying Claims to Medicare

By |2020-04-13T18:06:24+00:00October 15th, 2019|Coding Compliance Risk|

According to the United States DOJ, Traverse Anesthesia Associates, along with several anesthesiologists are paying over $600K to resolve allegations that they consciously incorrectly submitted certain anesthesia claims to Medicare. Investigators mentioned that TAA and six of their anesthesiologists didn't meet the regulative needs and conditions of payment for billing those services as medically directed. [...]

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