DOJ Pursues a Number Of EHR Cases: Five Things For You to Understand

The United States DOJ is initiating direct legal proceedings against Hospitals, Health Care systems, and Medical Technology Corporations for submitting an exhaustive number of false claims to both Medicare and Medicaid. This action is in concordance with the Electronic Health Records (EHR) incentive program, per the National Law Review. Click Here to Read the Full [...]

By |2019-06-18T22:10:55+00:00June 21st, 2019|Medical Coding News and Recent Articles|Comments Off on DOJ Pursues a Number Of EHR Cases: Five Things For You to Understand

Los Angeles Doctor Condemned In 33 Million Dollar Fraud Scheme

A United States Federal Jury found Dr. Robert Glazer guilty on June 7th for his primary role during a 33 million dollar fraud scheme concerning requests of Medicare for care services that were not actually provided. Following a seven-day trial, Dr. Glazer was found guilty of a single count of Conspiracy to Commit Fraud and [...]

By |2019-06-18T22:05:06+00:00June 20th, 2019|Medical Coding News and Recent Articles|Comments Off on Los Angeles Doctor Condemned In 33 Million Dollar Fraud Scheme

Kansas Doctor Forks Over Almost 6 Million in Settling 3rd False Claims Case in Twenty Years

Joseph P. Galichia MD, the previous owner of the Wichita-based Galichia Medical, after quite some time, reached Fraud Claim Act settlements with the Feds in 2000 and 2009 amounting to nearly 6 Million Dollars. This was his third time settling with the US Federal Government for such behavior. Click Here to Read the Full Story!

By |2019-06-18T21:55:27+00:00June 19th, 2019|Medical Coding News and Recent Articles|Comments Off on Kansas Doctor Forks Over Almost 6 Million in Settling 3rd False Claims Case in Twenty Years

Westside Los Angeles Dentist Being Sent To Prison

A West Los Angeles dental practitioner was sentenced last week to forty months in federal jail for a health-care insurance fraud scheme during which he submitted phony billings for crowns and fillings that were not ever really provided to patients. Benjamin Rosenberg, 59, pleaded guilty in January to one federal count of health care fraud, [...]

By |2019-06-18T21:42:54+00:00June 18th, 2019|Medical Coding News and Recent Articles|Comments Off on Westside Los Angeles Dentist Being Sent To Prison

Florida Physicians and Practice Settle False and Fraudulent Claims Case

Jaime L. Sepulveda, MD, LLC (d/b/a Miami Urogynecology Center), Jaime L. Sepulveda, M.D., and Sujata Yavagal, M.D. (collectively, "Miami Urogynecology Center"), South Miami, Florida, entered into a $173,768.08 settlement agreement with OIG. The settlement agreement resolves allegations that Miami Urogynecology Center submitted claims to Medicare for items or services that it knew or should have [...]

By |2019-06-18T03:12:03+00:00June 18th, 2019|Medical Coding News and Recent Articles|Comments Off on Florida Physicians and Practice Settle False and Fraudulent Claims Case

Connecticut Diagnostic Services Provider Settles Case Involving False Claims

On November 19, 2018, Southern Connecticut Vascular Center, LLC (SCVC), Stratford, Connecticut, entered into a $792,076.76 settlement agreement with OIG. The settlement agreement resolves allegations that SCVC submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 96965 when those claims were for a procedure that was already included as a component of the duplex ultrasound [...]

By |2019-06-13T22:42:17+00:00June 14th, 2019|Medical Coding News and Recent Articles|Comments Off on Connecticut Diagnostic Services Provider Settles Case Involving False Claims

California Physician and Practice Settle Case Involving False Claims

On December 20, 2018, Michael Jadali, D.O., and the Center for Pain & Rehabilitation Medicine (collectively, "Dr. Jadali"), San Jose, California, entered into a $60,406.30 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Jadali submitted claims to Medicare for Healthcare Common Procedure Coding System codes 80500 (clinical pathology consultation; limited, without review of [...]

By |2019-06-13T22:41:22+00:00June 14th, 2019|Medical Coding News and Recent Articles|Comments Off on California Physician and Practice Settle Case Involving False Claims

California Physician and Practice Settle False and Fraudulent Claims Case

On April 12, 2019, Complete Women Care, Inc., and Miriam Mackovic-Basic, M.D. (collectively, "CWC"), with multiple locations in Los Angeles County, California, entered into a $258,045 settlement agreement with OIG. The settlement agreement resolves allegations that CWC submitted claims to Medicare for items or services that it knew or should have known were not provided as [...]

By |2019-06-13T16:14:32+00:00June 13th, 2019|Medical Coding News and Recent Articles|Comments Off on California Physician and Practice Settle False and Fraudulent Claims Case

Los Angeles Dental Practitioner Sentenced to Forty Months in Jail for Role in $3.8 Million Health Care Fraud Scheme

A LA, California-based dental practitioner was sentenced to forty months in jail last week for his role during a $3.8 million health care fraud scheme during which he charged various dental insurance carriers for crowns and fillings that were not ever actually provided to patients. Assistant Attorney General Brian A. Benczkowski of the Justice Department’s [...]

By |2019-06-12T17:37:04+00:00June 12th, 2019|Medical Coding News and Recent Articles|Comments Off on Los Angeles Dental Practitioner Sentenced to Forty Months in Jail for Role in $3.8 Million Health Care Fraud Scheme

Medicare Advantage Provider To Pay $30 Million To Settle Alleged Overpayment Of Medicare Advantage Funds

Sutter Health LLC, a California-based healthcare services provider, and several affiliated entities, Sutter East Bay Medical Foundation, Sutter Pacific Medical Foundation, Sutter Gould Medical Foundation, and Sutter Medical Foundation, have agreed to pay $30 million to resolve allegations that the affiliated entities submitted inaccurate information about the health status of beneficiaries enrolled in Medicare Advantage [...]

By |2019-06-04T20:45:42+00:00June 4th, 2019|Medical Coding News and Recent Articles|Comments Off on Medicare Advantage Provider To Pay $30 Million To Settle Alleged Overpayment Of Medicare Advantage Funds