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Repeal of MIPS – Recommendation to Congress, MedPAC 12 to 4 Vote

By |January 13th, 2018|

A top Congressional advisory body has voted to recommend that Congress repeal the Merit-based Incentive Payment System (MIPS) and replace it with a simpler quality reporting system that would not be mandatory in the way that MIPS is.

The 14-2 vote by members of the Medicare Payment Advisory Committee (MedPAC) was criticized by some […]

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Medicare Advantage Organization and Former COO to Pay $32.5 Million to Settle False Claims Act Allegations

By |June 2nd, 2017|

Freedom Health Inc., a Tampa, Florida-based provider of managed care services, and its related corporate entities (collectively “Freedom Health”), agreed to pay $31,695,593 to resolve allegations that they violated the False Claims Act by engaging in illegal schemes to maximize their payment from the government in connection with their Medicare Advantage plans, the Justice Department […]

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OIG Posts a Resource Compliance Guide & Enforcement Action

By |March 29th, 2017|

You can use the links provided and go directly to the OIG material.

The OIG has developed free educational resources listed are to help health care providers, practitioners, and suppliers understand the health care fraud and abuse laws and the consequences of violating them. These compliance education materials can also provide ideas for ways […]

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Medical Billing Codes Key to Fraud Case Against 2 Erie Oral Surgeons

By |August 8th, 2016|

John F. Lehrian, who is retired, and David E. Palo, of what was known as Lehrian & Palo Oral Surgery, 100 State St., pleaded not guilty to federal charges that they the defrauded insurance companies of more than $323,000. They were indicted July 12 on charges of health care fraud. The government is alleging Lehrian […]

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US Attorney’s Office Recovers Over $20 Million Dollars Against Community Health Network

By |July 2nd, 2015|

In another instance of false claims to Medicare and Medicaid programs, Josh J. Minkler, United States Attorney, announced today a $20,324,902.22 civil settlement with Community Health Network (ACHN), a non-profit health system with more than 200 sites of care and affiliates throughout the State of Indiana.

You can read the full article on the justice.gov website here […]

Government Recovers $3.3 billion in Fiscal 2014 Federal Health Program Fraud

By |March 19th, 2015|

WASHINGTON–The government recovered $3.3 billion in fiscal 2014 from individuals and companies that tried to defraud federal health programs, part of an effort by the Obama administration to improve enforcement and prevent abusive billing practices.

The administration recovered $7.70 for every dollar spent investigating health-care-related fraud and abuse in the past three years, according to a […]

New Medicare Rules Aim to Reduce Suspicious Billing Abuse

By |December 3rd, 2014|

Announced in the Wall Street Journal on Dec 3, 2014, the Obama administration has strengthened Medicare’s authority to kick doctors and other medical providers out of the federal program for abusively billing the government.

Here’s a quick summary of the key points / changes in this important federal program:

move represents a significant shift in how the […]

Second quarter PQRS interim claims feedback data available

By |November 27th, 2014|

Eligible professionals (EPs) who reported at least one PQRS quality measure during 2014 via claims-based reporting can access their data on a quarterly basis using the 2014 PQRS Interim Feedback Dashboard. The Centers for Medicare & Medicaid Services (CMS) announced that second quarter interim reports are now available for EPs who submitted data via claims […]

Radiology Billing Company To Pay $1.95 Million To Resolve False Claims Act Allegations

By |October 16th, 2014|

ATLANTA – The United States Attorney’s Office announced that it has reached a settlement with Medical Business Service, Inc. (MBS), which agreed to pay $1.95 million to settle claims that it violated the False Claims Act by fraudulently changing diagnosis codes on claims to Medicare and Medicaid, in order to get the rejected claims paid […]

Physical Therapy Providers – The OIG Might Want to Look at Your Records Too

By |September 20th, 2014|

In this article in the AACP (2014 Archive), Lynn S. Berry, PT, CPCPT, warns “PT Take Heed: The OIG Might Want to Look at Your Records, Too”.

More speciafically, Lynn Berry suggests that physical therapy (PT) providers should go to the website, put in their NPI numbers or names, and see where their Medicare billing stood […]