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Florida AG Arrests Dentist and Office Manager for More Than $50,000 in Medicaid Fraud

Attorney General Pam Bondi and the Pembroke Pines Police Department arrested a dentist and their office manager for defrauding the Medicaid program out of more than $50,000.

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By |February 8th, 2018|Medical Coding News and Recent Articles|Comments Off on Florida AG Arrests Dentist and Office Manager for More Than $50,000 in Medicaid Fraud

Bucks County dentist charged with $1.5M Medicaid fraud

Ilya Babiner, a Bucks County dentist, was charged Wednesday with 55 third-degree felony counts. Allegedly, the dentist filed a number of claims to the Medical Assistance Program between 2014 and 2016 seeking compensation for $1.5 million in work he never performed, according to the state Office of Attorney General.

 

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By |February 5th, 2018|Medical Coding News and Recent Articles|Comments Off on Bucks County dentist charged with $1.5M Medicaid fraud

Scripps will pay $1.5M to settle billing fraud case

Scripps Health in San Diego has agreed to settle allegations it violated the False Claims Act (paying $1.5 million), according to the Department of Justice. This resolves the allegations that Scripps had billed Medicare and Tricare for services provided by physical therapists who didn’t have the applicable billing privileges and were not supervised by an […]

By |January 25th, 2018|Medical Coding News and Recent Articles|Comments Off on Scripps will pay $1.5M to settle billing fraud case

CPT 2018 Changes for Orthopaedic Surgery

CPT 2018 Changes for Orthopaedic Surgery: It’s all about that Spine……almost

By Heidi Stout, CPC, COSC, CCS-P

 

Not much will change for orthopaedic surgery coding in 2018.  Most of the changes in CPT 2018 to the Musculoskeletal System codes (20005-29999) and Nervous System- Spine And Spinal Cord codes from 2017, including additions, deletions, and revisions, impact the […]

By |January 15th, 2018|Medical Coding News and Recent Articles|Comments Off on CPT 2018 Changes for Orthopaedic Surgery

Repeal of MIPS – Recommendation to Congress, MedPAC 12 to 4 Vote

A top Congressional advisory body has voted to recommend that Congress repeal the Merit-based Incentive Payment System (MIPS) and replace it with a simpler quality reporting system that would not be mandatory in the way that MIPS is.

The 14-2 vote by members of the Medicare Payment Advisory Committee (MedPAC) was criticized by some […]

By |January 13th, 2018|Medical Coding Audits and Compliance, Medical Coding News and Recent Articles|Comments Off on Repeal of MIPS – Recommendation to Congress, MedPAC 12 to 4 Vote

Charleston dentist sentenced to five years in federal prison for health care fraud

A Charleston dentist who falsely billed West Virginia Medicaid for more than $700,000 was sentenced today to 5 years in federal prison. Skaff, a dentist, admitted that he falsely inflated his billings (a practice commonly known as upcoding) by falsely claiming reimbursement for procedures involving impacted teeth (typically, only wisdom teeth are impacted). However, Skaff upcoded billings […]

By |December 18th, 2017|Medical Coding News and Recent Articles|Comments Off on Charleston dentist sentenced to five years in federal prison for health care fraud

Utah Pain Doctor and Medical Practice Settle Medicare Fraud Claims

On July 21st, 2017, Jahan Imani, M.D., and Intermountain Medical Management, P.C., (IMM), a Utah based pain management specialist and his practice, entered into a $399,895.92 settlement agreement with OIG. This resolves allegations that IMM, through Dr. Imani, submitted false or fraudulent claims for payment by inappropriately using modifier 59 for multiple units of HCPCS […]

By |November 5th, 2017|Medical Coding News and Recent Articles|Comments Off on Utah Pain Doctor and Medical Practice Settle Medicare Fraud Claims

Syracuse Area Medical Practice Improperly Billed for Moderate Sedation Services

New York Spine and Wellness Center (under the umbrella of New York Anesthesiology Medical Specialties, P.C.) agreed today to pay $1,941,850.29 to resolve allegations that it improperly billed for moderate sedation services.

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By |November 1st, 2017|Medical Coding News and Recent Articles|Comments Off on Syracuse Area Medical Practice Improperly Billed for Moderate Sedation Services

Under Michigan’s New Medicare RAC Regime, Physician Services Are the Initial Primary Target

An announcement came back in back in October 2016 from the Centers for Medicare & Medicaid Services (CMS). It announced that it had awarded to various entities the next round of contracts to serve as Recovery Audit Contractors (RACs) for their Medicare program. In totality, five separate RAC contractors were awarded. Each one was connected […]

By |September 5th, 2017|Medical Coding News and Recent Articles|Comments Off on Under Michigan’s New Medicare RAC Regime, Physician Services Are the Initial Primary Target

Civil Fraud Case Settlement from Fredericksburg Hospitalist Group amounts to $4.2 Million

Along with 14 of its member shareholders, Fredericksburg Hospitalist Group has agreed to pay nearly $4.2 million to settle a federal False Claims Act case brought under the qui tam whistleblower provisions of the FCA.

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By |September 1st, 2017|Medical Coding News and Recent Articles|Comments Off on Civil Fraud Case Settlement from Fredericksburg Hospitalist Group amounts to $4.2 Million