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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.

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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.

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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

Texas Dental Management Firm Agree to Pay $8.45 Million to Resolve Allegations

Texas-based MB2 Dental Solutions (MB2), 21 pediatric dental practices affiliated with them, as well as their owners and marketing chief, all have agreed to pay the US and Texas Medicaid $8.45 million to settle allegations that they violated the False Claims Act. They are accused of knowingly submitting, or otherwise causing the submission of, claims […]

By |January 13th, 2017|Medical Coding News and Recent Articles|Comments Off on Texas Dental Management Firm Agree to Pay $8.45 Million to Resolve Allegations

Mother and Son Sentenced to Prison for Involvement in 95 Million Dollar Scam

A mother and son based in Miami were sentenced today to 120 months and 30 months in prison, respectively, for their roles in spearheading a $9.5 million health care fraud conspiracy that targeted Medicare Part D.

Read full story here: https://www.justice.gov/opa/pr/mother-sentenced-120-months-prison-son-sentenced-30-months-prison-involvement-95-million

By |November 21st, 2016|Medical Coding News and Recent Articles|Comments Off on Mother and Son Sentenced to Prison for Involvement in 95 Million Dollar Scam

Springfield Psychiatrist Ordered to Pay $908,000

SPRINGFIELD, Ill. – U.S. District Judge Sue E. Myerscough has entered judgment in favor of the government and against a Springfield psychiatrist, Duttala Obul Reddy, for $908,000, to settle allegations of false billing, as announced by U.S. Attorney Jim Lewis.

Read full story here: https://www.justice.gov/usao-cdil/pr/springfield-psychiatrist-ordered-pay-908000-civil-settlement

By |November 18th, 2016|Medical Coding News and Recent Articles|Comments Off on Springfield Psychiatrist Ordered to Pay $908,000

Detroit Area Home HealthCare Agency Co-owner Sentenced to 96 Months

The co-owner of a Detroit home health care company was sentenced today to 96 months in prison for his role in a Medicare fraud scheme that caused approximately $33 million in losses.

See the full story here: https://www.justice.gov/opa/pr/detroit-area-home-health-care-agency-co-owner-sentenced-96-months-prison-33-million-medicare

By |November 16th, 2016|Medical Coding News and Recent Articles|Comments Off on Detroit Area Home HealthCare Agency Co-owner Sentenced to 96 Months