Evaluation & Management Coding Handbook 2018
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 [...]
Georgia Emergency Physicians Sue Anthem Over ER Policy
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!
Southwest Orthopaedics Physicians to Pay Settlement
9 specialists from Southwest Orthopaedics (based in OKC) agreed to pay $670,000 to settle civil claims stemming from allegations they submitted false claims. Read the full story here!
Montana Hospital Employee Email Hacked
The email account of a Montana Clinic employee was hacked in May while they were oversas, potentially compromising the information of over 8000 patients. Read full story here!
Medicare Proposed Virtual Care Reimbursement
CMS made a series of suggestions to expand telehealth in its latest Medicare Physician Fee Schedule and Quality Payment Program. Read full story here!
Liberty Ambulance Service investigated for fraudulently billing federal agencies
Liberty Ambulance Service, located in Jacksonville, has agreed to a $1.2 million settlement. This is in response to allegations that it, for more than 10 years, fraudulently billed federal health benefits [...]
Allstate Files $2M Suit
Allstate, one of the largest insurance companies in the world, has filed 81 fraud lawsuits in New York since 2003. Most recently, the company filed another suit against 13 new corporations. [...]
Sanford Health to expand into Chicago market
Five years after South Dakota-based Sanford Health failed to acquire Minneapolis-based Fairview Health Services, the 45-hospital system is looking to expand outside of state lines for the second time and [...]
FWC Urogynecology Agrees To Pay $1.7 Million in Settlement
US Attorney Maria Lopez announced that FWC Urogynecology, LLC, in Florida, has agreed to pay the US $1,700,000.00 to resolve allegations that it violated the False Claims Act by knowingly [...]
Orthopedic Surgeon in $700K fraud scheme
CA-based physician Gary Royce Wisner, MD, was scheduled for arraignment June 13 on 11 felony counts of insurance fraud. Read Full Story Here!