CMS Selects Primary Care Payment Model Participants

CMS selects primary care payment model participants According to Becker's Hospital Review, "CMS chose 916 primary care practices and 37 regional health plan partners as participants in its new payment model called Primary Care First. PCF was designed to decrease the amount of avoidable hospital visits and total cost of care through performance-based adjustments. The [...]

By |2020-11-24T21:41:49+00:00November 24th, 2020|Medical Coding Audits and Compliance|Comments Off on CMS Selects Primary Care Payment Model Participants

OIG Tags Arizona Hospital for Erroneous Billing

OIG Tags Arizona Hospital for Erroneous Billing Flagstaff (Ariz.) Medical Center failed to comply with Medicare billing requirements for three of 100 inpatient and outpatient claims reviewed by HHS' Office of Inspector General, according to an OIG report. The three claims that did not comply with Medicare billing requirements resulted in Flagstaff Medical Center receiving [...]

By |2020-11-12T21:58:55+00:00November 12th, 2020|Medical Coding Audits and Compliance|Comments Off on OIG Tags Arizona Hospital for Erroneous Billing

Neurosurgeon Medical Practice Director to Pay Over $1 Million

Neurosurgeon Medical Practice Director to Pay Over $1 Million Neurosurgeon Medical Practice Director to Pay Over $1 Million to Resolve False Claims Act Liability Arising from Billing of P-Stim Devices. PHILADELPHIA – First Assistant United States Attorney Jennifer Arbittier Williams announced that neurosurgeon Sagi M. Kuznits, practice director Pnina Kuznits, and Neurosurgical Care LLC (collectively, [...]

By |2020-11-12T21:54:38+00:00November 12th, 2020|Medical Coding Audits and Compliance|Comments Off on Neurosurgeon Medical Practice Director to Pay Over $1 Million

New Mexico Physician and Practice Settle Case Involving False Claims

New Mexico Physician and Practice Settle Case Involving False Claims The settlement agreement resolves allegations that Dr. Reddy submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 93965, when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which Dr. Reddy submitted claims using [...]

By |2020-11-12T21:54:10+00:00November 12th, 2020|Medical Coding Audits and Compliance|Comments Off on New Mexico Physician and Practice Settle Case Involving False Claims

Texas Physician and Practice Settle Case Involving False Claims

Texas Physician and Practice Settle Case Involving False Claims The settlement agreement resolves allegations that Dr. Robbins submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 93965, when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which Dr. Robbins submitted claims using HCPCS [...]

By |2020-11-12T21:53:15+00:00November 12th, 2020|Medical Coding Audits and Compliance|Comments Off on Texas Physician and Practice Settle Case Involving False Claims

Illinois Physician Settles Case Involving False Claims

Illinois Physician Settles Case Involving False Claims The settlement agreement resolves allegations that Dr. Tolitano submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 93965, when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which Dr. Tolitano submitted claims using HCPCS codes 93970 [...]

By |2020-11-12T21:50:06+00:00November 12th, 2020|Medical Coding Audits and Compliance|Comments Off on Illinois Physician Settles Case Involving False Claims

Pain Doctor Pays to Settle Allegations of Deceptive Medicare Billing

Pain doctor pays to settle allegations of deceptive Medicare billing. A 52-year-old pain management physician from Houston has paid $530,000 to resolve allegations he falsely billed Medicare for the use of electro-acupuncture devices, announced U.S. Attorney Ryan K. Patrick. From March 1, 2019, to Oct. 31, 2019, Dr. Syed Nasir billed Medicare for the implantation [...]

By |2020-11-12T21:48:41+00:00November 12th, 2020|Medical Coding Audits and Compliance|Comments Off on Pain Doctor Pays to Settle Allegations of Deceptive Medicare Billing

Tallahassee Health Care Provider Arrested for Medicaid Fraud

Tallahassee Health Care Provider Arrested for Medicaid Fraud A Tallahassee health care provider has been arrested for billing the Florida Medicaid Program around $50,000 for fraudulent medical services, according to Florida Attorney General Ashley Moody. Rodney Burt, 57, was arrested Friday on Medicaid fraud charges after he billed the state’s Medicaid program for phony services [...]

By |2020-11-12T21:48:17+00:00November 12th, 2020|Medical Coding Audits and Compliance|Comments Off on Tallahassee Health Care Provider Arrested for Medicaid Fraud

Federal Judge Sentences Former Manager of Kalamazoo-area OB-GYN Practice

Federal judge sentences former manager of Kalamazoo-area OB-GYN practice. Federal officials said U.S. District Judge Janet Neff found that Sabor was complicit in several fraud schemes committed by the practice, resulting in about $914,000 in false claims submitted by Urological Solutions of Michigan and paid by Medicare. Scheme included billing pelvic muscle rehabilitation therapy using [...]

By |2020-11-12T21:47:45+00:00November 12th, 2020|Medical Coding Audits and Compliance|Comments Off on Federal Judge Sentences Former Manager of Kalamazoo-area OB-GYN Practice

Guam Ambulance Company Owners Sentenced to Prison for Their Roles in Medicare Ambulance Fraud Scheme

Guam Ambulance Company Owners Sentenced to Prison for Their Roles in Medicare Ambulance Fraud Scheme. Two owners of Guam Medical Transport (GMT) were sentenced to prison terms today for their roles in a health care fraud and money laundering scheme that resulted in a loss to the United States of approximately $10.8 million, one of [...]

By |2020-11-12T21:47:11+00:00November 12th, 2020|Medical Coding Audits and Compliance|Comments Off on Guam Ambulance Company Owners Sentenced to Prison for Their Roles in Medicare Ambulance Fraud Scheme