Coding Compliance Risk

Company Owner Goes to Jail for Medicaid Fraud

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

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 [...]

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

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

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. [...]

Virginia Beach Psychiatrist Grossly Over-booked Patients as Part of Fraud

By |2020-04-13T18:06:34+00:00September 26th, 2019|

A psychiatrist double, triple and even quadruple overbooked patients at his Virginia Beach practices so as to over bill insurance firms by over $460,000, per court documents. Udaya Shetty, of behavioral & medicine group and a lot of recently Quietly Radiant Psychiatric Services, pleaded guilty Wednesday to at least one count of health care fraud. [...]

Doctor’s Practice to Pay Nearly $180K to Resolve False Claims Act Liability Regarding “P-Stim” Devices

By |2020-04-13T18:06:44+00:00September 24th, 2019|

First Assistant U.S. Lawyer Jennifer Arbittier Williams proclaimed that Richard P. Frey, D.O., and Physicians Alliance Ltd. (“PAL”) have agreed to pay nearly $180,000 to resolve liability underneath the False Claims Act for the alleged improper charge of “P-Stim” devices. From may 2013 through June 2014, Frey and PAL billed Medicare for the implantation of [...]

Announcements from the OIG (September 2019)

By |2020-04-13T18:06:58+00:00September 20th, 2019|

Alabama Ambulance Provider Settles Case Involving False Claims On June 28, 2019, Samaritan EMS, Inc. (Samaritan), Union Grove, Alabama, entered into a $942,373.67 settlement agreement with OIG. The settlement agreement resolves allegations that Samaritan submitted basic and advanced life support ambulance claims where the trips were to destinations for which ambulance services are not covered by [...]

The OIG calls out a CA Medical Group for Inaccurate Charges

By |2020-04-13T18:07:08+00:00September 12th, 2019|

Santa Monica, California based Oceanside MedicalGroup did not comply with Medicare necessities when charging for psychotherapy services, in keeping with a report from Health and Human Service's OIG. The Office of Inspector General said none of the hundred sampled beneficiary days, comprising of 103 psychotherapy services, complied with Medicare any needs. Furthermore, within the majority of cases, [...]

RUC & CMS: The Difference Between Them Could Mean Money To Doctors

By |2020-04-13T18:07:15+00:00August 22nd, 2019|

Physicians ought to review the direct monetary impact as several of the managed care contracts can pay these auxiliary services at the CMS RVU rates. the great news is they aren't set in stone; so doctors can discuss the projected WRVUs or the other a part of the rule until September 27th. Read The Full [...]

Gate City Transportation Sentenced For Health Care Fraud For Over $5 Million

By |2020-04-13T18:07:24+00:00August 19th, 2019|

A Greensboro-based medical transport company was sentenced in court for health care fraud after pleading guilty to one count of health care fraud in October 2018, according to US Attorney lawyer Matthew G.T. Martin of the District of North Carolina. The company in question, Gate City Transportation, was ordered to pay a $100 fine, a [...]

Medicare Advantage Supplier and Doctor to Pay $5 Million to Settle False Claims Act Allegations

By |2020-04-13T18:07:33+00:00August 14th, 2019|

Beaver Medical Group L.P. (BMG) and a doctor who works for it, Dr. Sherif Khalil, have agreed to pay a little over the amount of $5 million to resolve accusations that they falsely reported diagnosis codes to plans of Medicare Advantage, thereby causing said plans to receive inflated payments. BMG is headquartered in Redlands, CA. “The [...]

Proposed Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2020

By |2020-04-13T18:07:41+00:00August 1st, 2019|

On July 29, 2019, the Centers for Medicare Services (CMS) issued a projected rule that has proposals to update payment policies, payment rates, and quality provisions for services equipped beneath the Medicare Physician Fee Schedule (PFS) on or after Jan 1, 2020. The Calendar Year (CY) 2020 PFS projected rule is one amongst many planned [...]