MGMA Launches RAC WATCH - Increased RAC Audit Activity
Medicare Recovery Audit Contractors (RACs) are tasked with identifying and recouping overpayments and refunding underpayments. In fiscal year 2011, RACs identified $939.3 million in improper payments,...
View ArticleApex Medical Group Pays $4.36 Million For Federal & State Health Care Fraud
A government investigation revealed that from at least 2001 through 2006 Apex Medical Group in Knoxville, TN submitted numerous false and fraudulent claims to government health programs, including...
View ArticleDoctor Indicted of Insurance Billing and Medicare Fraud For Falsifying Diagnosis
A federal grand jury in Birmingham, AL indicted a physician for fraud totaling about $1.3 million for billing Blue Cross Blue Shield and Medicare for non-reimbursable cosmetic skin treatments. The...
View ArticleAmbulance Company To Pay $5.4 Million For Fraudulent Medicare Coding...
Rural / Metro Ambulance agreed to pay $5,426,000 for services improperly billed to Medicare. Medicare covers certain ambulance services only if the patients’ medical condition dictates that other means...
View ArticleFederal Fraud and Abuse Recoveries Exceed $2 Billion in FY 2011
The Department of Health and Human Services and the Department of Justice released their Health Care Fraud and Abuse Control Program Annual Report showing that the government recovered approximately...
View ArticleLeading Oncology Practice to Pay $4.1 Million to Settle False Claims Act...
Special Agents of the Federal Bureau of Investigation and Health & Human Services, Office of Inspector General nailed Georgia's premier hematology-oncology practice with a $4.1 million settlement...
View ArticleBaylor University To Pay $907,355 For False Medicare Claims For Radiation...
Baylor University’s Health Care System agreed to pay $907,355 to settle allegations that it submitted false claims to Medicare, Tricare, and FEHBP for various radiation oncology services, including...
View ArticleHealthcare fraud recoveries set record in 2012
The Department of Justice announced Tuesday that False Claims Act recoveries in 2012 set records, including for healthcare recoveries, which topped $3 billion.
View ArticleThe Affordable Care Act - a/k/a “OBAMACARE”
Much has been said and written about the the Affordable Care Act. Its 1,000 pages will have a "game changing" impact upon the healthcare industry and all of its "moving parts".
View ArticleDoctor, Office Manager , & Billing Company Owners Jailed For False Claims
An oncologist from Mississippi was sentenced to 20 years in federal prison followed by 3 years of probation plus a $250,000 fine, restitution of $8 million, the forfeiture of $6 million and another $6...
View ArticleCPT 2013 Preview - More Than 650 Code Changes
For 2013, CPT® there are more than 650 code changes, new and revised section guidelines and parenthetical instructions, and much more. Download link to AAPC article.
View ArticleRecovery Audit Contractor (RACs) Reviews for Outpatient Services
Be prepared and keep a watchful eye on the automated issues RACs are reviewing for outpatient services. Preparing for, and responding to, recovery audit contractor (RAC reviews can be intimidating. You...
View ArticleHealth & Human Services OIG Targets Documentation in Electronic Medical...
Each fall the Health & Human Services Office of the Inspector General releases its Work Plan for the next year. Here's an update on the 2013 work plan.
View ArticleFBI Nails Two Podiatrists for Upcoading Nail Trims
A podiatrist from Fenton, Michigan was sentenced to 55 months in Federal prison and his associate got 18 months plus they "jointly and severally" have to pay restitution of $1.4 million to Medicare and...
View ArticleNational Correct Coding Initiative Edit Changes to 590 Surgical Codes...
NCCI release 19.1 is effective April 1, 2013. This is probably the smallest change impact since the beginning of the program. There are 744 new edit pairs and only 32 terminated edit pairs.
View ArticleModifier -25 Is Targeted By The Feds - Hospital Agrees To Coding &...
The United States Department of Justice announced that Easton Hospital has agreed to pay the United States $454,866 to resolve allegations that it submitted improper claims to the Medicare program....
View ArticleImproper Modifier Use Going Back Ten Years Will Cost A Health System $1,029,791
The United States Attorney's Office for the Middle District of Pennsylvania announced that the St. Luke’s University Health Network has agreed to pay the United States $1,029,791 to resolve allegations...
View ArticleASC Colonoscopy Clarifications - New Reporting Requirements
The takeaways from this report by By Denis Rodriguez, CPCi posted in www.aacp.com are as follows: • ChangestothereportingandpaymentofcolonoscopiesinASCs require knowledge of commercial payer and...
View ArticleLas Vegas Urology Practice Agrees To Pay U.S. Department Of Justice $1 Mi
Las Vegas Urology Practice Agrees To Pay U.S. Department Of Justice $1 Million To Settle Civil Health Care Fraud Allegations
View ArticleAudit Compliance Plan - Ensure Documentation Supports Reimbursement
As a physician auditor, Melody spends much of her time educating clinicians on proper documentation. This involves explaining and interpreting coding and compliance guidelines. When provid- ing such...
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