Medical Coding Audits and Compliance

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

By |2020-04-13T06:43:01+00:00August 8th, 2016|Medical Coding Audits and Compliance, Remote Medical Coding|

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 |2015-09-13T17:57:15+00:00July 2nd, 2015|Medical Coding Audits and Compliance|

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 [...]

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

By |2020-04-13T06:44:24+00:00March 19th, 2015|Medical Coding Audits and Compliance, Remote Medical Coding|

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 [...]

Second quarter PQRS interim claims feedback data available

By |2020-04-13T06:50:37+00:00November 27th, 2014|Medical Coding Audits and Compliance, Remote Medical Coding|

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 [...]

Medicare Fraud Hard to Stop, But Predictive Analytics Technology Helping

By |2020-04-13T18:24:28+00:00August 16th, 2014|Coding Compliance Risk, Medical Coding Audits and Compliance|

In this article by REED ABELSON and ERIC LICHTBLAU at the NEW YORK TIMES, Medicare says its new high tech predictive analytics system “is successfully doing its job of pointing the spotlight on bad behavior and prioritizing the most egregious situations for investigation.” However, due to poor managment controls, limited sharing of information and the extensive number [...]

Increased Audits of E&M Services by CMS – Recommendations from OIG

By |2020-04-13T06:52:24+00:00June 19th, 2014|Medical Coding Audits and Compliance, Remote Medical Coding|

Posted: 16 Jun 2014 12:58 PM PDT In May of 2014, the Office of the Inspector General (OIG) released a report detailing its findings regarding Medicare payments for evaluation and management (E/M) services. E/M services are performed by physicians in order to assess and manage a beneficiary's health. The OIG found that coding errors in [...]