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Maryland Treatment Centers Agrees to Pay $500,000 to Resolve Allegations That It Submitted Claims for Services That Were Undocumented or Not Provided

Maryland Treatment Centers has consented to pay the United States $500,000 to settle charges under the False Claims Act that it submitted false cases to the United States for psychological wellness and substance misuse benefits that were undocumented or not given. Maryland Treatment Centers, including its subsidiary Mountain Manor Treatment Centers, offers emotional well-being and […]

By |November 21st, 2018|Medical Coding News and Recent Articles|Comments Off on Maryland Treatment Centers Agrees to Pay $500,000 to Resolve Allegations That It Submitted Claims for Services That Were Undocumented or Not Provided

Clinician Letter Reducing Burden Documentation

By |November 19th, 2018|Medical Coding News and Recent Articles|Comments Off on Clinician Letter Reducing Burden Documentation

Final Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2019

Final Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2019

On November 1, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or […]

By |November 17th, 2018|Medical Coding News and Recent Articles|Comments Off on Final Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2019

CMS says it will recover $1B in ill-advised Medicare installments by 2020

CMS said it is ready to hook back $1 billion from Medicare Advantage associations by 2020 through far reaching reviews, as indicated by a proposed standard.

Here are five things to know:

1. The standard, set to hit the government enroll Nov. 1, concerns chance alteration information approval reviews for Medicare Advantage associations. RADV reviews happen after […]

By |November 15th, 2018|Medical Coding News and Recent Articles|Comments Off on CMS says it will recover $1B in ill-advised Medicare installments by 2020

Medicare fraud by All Saints Anesthesiologists

From 2011 to somewhere around 2014, Ascension All Saints Hospital’s contracted anesthesiology aggregate efficiently overbilled Medicare and Medicaid for many dollars, as indicated by a government claim. It was brought by an informant who trusts he was let go for declining to take an interest in the supposed overbilling plan.

By |October 23rd, 2018|Medical Coding News and Recent Articles|Comments Off on Medicare fraud by All Saints Anesthesiologists

Update: CMS’s Proposed Changes to the Physician Fee Schedule for 2019

Following up on our September 4th, 2018 post “MGMA Opposes Proposal to Consolidate E/M Codes”, The Coding Network has been actively tracking the status of the sweeping changes to the Physician Fee Schedule for 2019 proposed by the Centers for Medicare & Medicaid Services. The complete language of CMS’s proposed rule can be found online at https://www.regulations.gov/document?D=CMS-2018-0076-0621.  According […]

By |October 17th, 2018|Medical Coding News and Recent Articles|Comments Off on Update: CMS’s Proposed Changes to the Physician Fee Schedule for 2019

Stuart Doctor Charged in Twenty-Six Count Federal Health Care Fraud Indictment

A specialist has been accused of submitting social insurance misrepresentation out of her training in Stuart, Florida. The U.S. Lawyer for the Southern District of Florida, Shimon R. Richmond, Special Agent in Charge, U.S. Division of Health and Human Services, Office of Inspector General (HHS-OIG), Miami Regional Office, Robert F. Lasky, Special Agent in Charge, […]

By |October 16th, 2018|Medical Coding News and Recent Articles|Comments Off on Stuart Doctor Charged in Twenty-Six Count Federal Health Care Fraud Indictment

Medicaid and Medicare Telehealth Payments Fails to Meet Medicare Requirements

OIG reviewed 191,118 Medicare paid distant-site telehealth claims, totaling $13.8 million, that did not have corresponding originating-site claims. The watchdog agency then reviewed provider supporting documentation to determine whether the services met Medicare’s requirements for reimbursement. 31% of the telehealth claims did not. Specifically:

24% were unallowable because the beneficiaries received services at nonrural originating […]

By |October 12th, 2018|Medical Coding News and Recent Articles|Comments Off on Medicaid and Medicare Telehealth Payments Fails to Meet Medicare Requirements

Batesville Lady Blamed for Overbilling Medicaid for Preferred Family Health

A previous charging assistant at Preferred Family Health has been captured on doubt of Medicaid extortion. Vicki Chisam, 65, of Batesville is blamed for purposely putting forth false expressions to the Arkansas Medicaid Program from January 2015 to Nov. 9, 2015 in the interest of the facility. The excessive charges, as indicated by Attorney General […]

By |October 10th, 2018|Medical Coding News and Recent Articles|Comments Off on Batesville Lady Blamed for Overbilling Medicaid for Preferred Family Health

Southeastern Connecticut Doctor Settles under the False Claims Act for Nearly 100K

John H. Durham, United States Attorney for the District of Connecticut, today declared that HELAR CAMPOS, MD, a doctor with a training in New London and Norwich, has gone into a common settlement with the administration in which he will pay $99,912 to determine charges that he abused the False Claims Act.

Read the Full Story […]

By |October 4th, 2018|Medical Coding News and Recent Articles|Comments Off on Southeastern Connecticut Doctor Settles under the False Claims Act for Nearly 100K