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$65M False Claims Act Lawsuit Shows Need To Improve Coding & CDI Compliance

By |September 19th, 2018|

In August, Ontario, Calif.- based Prime Healthcare Services paid $65 million to settle assertions it disregarded the False Claims Act by conceding patients who just required outpatient mind and participating in upcoding.

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AMA Releases 335 Coding Changes For 2019

By |September 14th, 2018|

The American Medical Association has released the 2019 Current Procedural Terminology code set.

The code set was released Aug. 31, and the AMA announced the release Sept. 5.

Six things to know:

1. The new code set consists of 335 code changes.

2. Code changes include three new remote patient monitoring codes, as well as two new interprofessional internet […]

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Detroit Podiatrist Goes To Prison for Health Care Fraud

By |September 13th, 2018|

A Detroit-territory podiatrist was condemned to 28 months in jail today for his investment in a $1 million plan including podiatry benefits that were charged to Medicare however were never rendered.

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AMA Releases 335 Coding Changes For 2019

By |September 7th, 2018|

The American Medical Association has released the 2019 Current Procedural Terminology code set.

The code set was released Aug. 31, and the AMA announced the release Sept. 5.

Six things to know:

1. The new code set consists of 335 code changes.

2. Code changes include three new remote patient monitoring codes, as well as two new interprofessional internet […]

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MGMA Opposes Proposal to Consolidate E/M Codes

By |September 4th, 2018|

Inside the proposed medical doctor price agenda, the facilities for Medicare & Medicaid services (CMS) positioned forth numerous coverage modifications on E/M documentation and fee. MGMA and a coalition of main healthcare groups voiced robust competition to the notion to fall apart payment charges for eight workplace visit services down to two each however are […]

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New York Doctor Imprisoned For $30M Scheme

By |August 31st, 2018|

Dr. Ewald Antoine pleaded guilty to healthcare fraud, as well as several other crimes. According to the indictment, Dr. Antoine posed as the owner of two clinics in Brooklyn, falsely claiming he examined and treated hundreds of patients there.

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Northwest ENT Associates, P.C. to pay approximately $1.2 million to resolve False Claims Act allegations

By |August 29th, 2018|

Northwest ENT Associates, P.C. (“Northwest ENT”), a Marietta, Georgia based professional corporation, has agreed to pay $1,195,361 to resolve allegations that it violated the False Claims Act by submitting claims for sinus dilation procedures in which it re-used balloon catheters that were intended for single use only.

“When healthcare providers take shortcuts in order to increase […]

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California Physician and Practice Settle False and Fraudulent Claims Case

By |August 27th, 2018|

On June 11, 2018, James S. Dunn, Jr., MD, d/b/a Auburn Urogynecology and Women’s Health (collectively, “Dr. Dunn”), Auburn, California, entered into a $419,578 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Dunn submitted claims to Medicare for items or services that he knew or should have known were not provided as […]

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Providence Health Sued Over Alleged $188 Million Medicare Upcoding Scheme

By |August 21st, 2018|

Providence Health and Services has been hit with a lawsuit alleging the health system violated the False Claims Act by purposely upcoding Medicare to increase reimbursement. The lawsuit, filed late last week in the U.S. District Court of Central California by data analysis firm Integra Med Analytics, claims Providence, with the help of an outside consultant, pushed physicians […]

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Whistleblower Sharing in Settlement from Prime Healthcare

By |August 20th, 2018|

A San Diego whistleblower will receive $17. 2 mil with the settlement of a 7-year-old false statements|lawsuit against Prime Healthcare Care regarding overbilling for Medicare services at California hospitals.

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