Carolina Healthcare System Agrees To Pay $6.5 Million

The Charlotte-Mecklenburg Hospital Authority, dba Carolinas Healthcare System (CHS), has agreed pay the Government $6.5 million according to U.S. Attorney Jill Westmoreland Rose. This was to resolve allegations that the company violated the False Claims Act, by “up-coding” claims for urine drug tests in order to receive higher payment than allowed for the tests. The settlement […]

By |July 6th, 2017|Medical Coding News and Recent Articles|Comments Off on Carolina Healthcare System Agrees To Pay $6.5 Million

Norman Orthopedic Practice Pays $1,537,796

Orthopedic and Sports Medicine Center-Norman (collectively “OSC”) have paid $1,537,796 to settle civil claims stemming from allegations that they submitted false claims to Medicare, Medicaid, the Department of Veterans Affairs, and TRICARE. In reaching this settlement, OSC did not admit liability, and the government did not make any concessions regarding the legitimacy of the claims. The agreement […]

By |June 28th, 2017|Medical Coding News and Recent Articles|Comments Off on Norman Orthopedic Practice Pays $1,537,796

Richmond Hospitalist Group Settles Federal FCA Case

Fredericksburg Hospitalist Group, located in Richmond, VA, and fourteen of its member shareholders have agreed to pay nearly $4.2 million to settle a federal FCA case brought under the “qui tam whistleblower” provisions. Dana J. Boente, U.S. Attorney for the Eastern District of Virgini, said, “Rooting out fraudulent billing by healthcare providers is a priority. This […]

By |June 19th, 2017|Medical Coding News and Recent Articles|Comments Off on Richmond Hospitalist Group Settles Federal FCA Case

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

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 […]

By |June 2nd, 2017|Medical Coding Audits and Compliance, Medical Coding News and Recent Articles|Comments Off on Medicare Advantage Organization and Former COO to Pay $32.5 Million to Settle False Claims Act Allegations

Medicare overbilled by $41.9M – Mount Sinai Hospital

New York City: According to a recent OIG report, Mount Sinai Hospital failed to comply with Medicare’s billing requirements for 110 outpatient and inpatient claims reviewed by the office of Inspector General for the audit period of January 1st, 2012, through December 31st, 2013.

Read the Full Story Here!

By |May 15th, 2017|Medical Coding News and Recent Articles|Comments Off on Medicare overbilled by $41.9M – Mount Sinai Hospital

Dermatologist in Encino to Pay $2.7 Million

Dr. Norman A. Brooks, M.D., the owner of The Skin Cancer Medical Center in Encino, has paid the United States nearly $2.7 million on April 10th to resolve allegations that he submitted bills to Medicare for Mohs micrographic surgeries for skin cancers that were medically unnecessary.

Read the Full Article here.

By |April 26th, 2017|Medical Coding News and Recent Articles|Comments Off on Dermatologist in Encino to Pay $2.7 Million

OIG Posts a Resource Compliance Guide & Enforcement Action

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 […]

By |March 29th, 2017|Medical Coding Audits and Compliance, Medical Coding News and Recent Articles|Comments Off on OIG Posts a Resource Compliance Guide & Enforcement Action

1 in 4 health consumers have had their PHI stolen

26% of United States health consumers have had their PHI stolen from healthcare systems, according to the results of a study from Accenture, released in Orlando at HIMSS17. The study reveals that 50% of people who experienced such a breach were victims of medical identity theft, and thus had to pay an average of $2,500 […]

By |February 21st, 2017|Medical Coding News and Recent Articles|Comments Off on 1 in 4 health consumers have had their PHI stolen

Healthcare Provider will pay $60 Million Settlement for Medicare and Medicaid False Claims

TeamHealth Holdings, a major U.S. hospital service provider, has agreed to resolve allegations that it violated the False Claims Act by billing Medicare, Medicaid, the DHA, and the Federal EHB Program for higher and more expensive levels of medical service than what were actually performed (a practice also known as “up-coding”), the DOJ announced today. […]

By |February 13th, 2017|Medical Coding News and Recent Articles|Comments Off on Healthcare Provider will pay $60 Million Settlement for Medicare and Medicaid False Claims

Federal government reclaims $3.3B+ in fraudulent healthcare claims

The Office of the Inspector General has reported that the federal government has recovered over $3 billion in fraudulent healthcare claims in the 2016 fiscal year.

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By |February 1st, 2017|Uncategorized|Comments Off on Federal government reclaims $3.3B+ in fraudulent healthcare claims