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A resigned New Haven oral specialist and his training consented to pay more than $ 250,000 to settle charges that they damaged government and state false case laws.
The post Resigned New Haven Oral Surgeon Settles False Claim Allegations appeared first on The Coding Network.
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 substance misuse administrations to youngsters and grown-ups in outpatient and inpatient areas in Maryland, including Baltimore and Rockville.
The post Maryland Treatment Centers Agrees to Pay $ 500,000 to Resolve Allegations That It Submitted Claims for Services That Were Undocumented or Not Provided appeared first on The Coding Network.
Northwest ENT Associates, P.C. (“Northwest ENT”), a Marietta, Georgia based professional corporation, has agreed to pay $ 1,195,361 to resolve allegations that it violated the False Claims Act by submitting claims for sinus dilation procedures in which it re-used balloon catheters that were intended for single use only.
“When healthcare providers take shortcuts in order to increase their financial bottom line, their patients are put at risk and federal funds are diverted from legitimate medical procedures,” said U. S. Attorney Byung J. “BJay” Pak. “This settlement demonstrates our commitment to pursuing healthcare providers who put their own financial well-being ahead of the well-being of their patients.”
“The goal of our agency is to protect the health and safety of the American tax payer,” said Derrick L. Jackson, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services. “We will continue to work with our law enforcement partners by investigating allegations where the health and safety of Medicare beneficiaries are at risk.”
“American consumers expect and deserve that the devices used by their health care practitioners during medical procedures are not only safe and effective, but also have been held under sanitary conditions,” said Peter Kuehl, Acting Special Agent in Charge, Food and Drug Administration, Office of Criminal Investigations’ Miami Field Office. “FDA remains fully committed to working with the Department of Justice and our law enforcement partners to hold those who place profits before the health and safety of patients fully accountable.”
“This settlement demonstrates the Government’s commitment to protect public funds that support the operations of our armed forces healthcare program (TRICARE) from fraud and abuse,” said John F. Khin, Special Agent in Charge, Defense Criminal Investigative Service-Southeast Field Office. “Every military contractor that submits claims must ensure that its claims are billed appropriately. DCIS and its partnering agencies will continue to vigorously pursue defense contractors that disregard billing requirements.”
“Federal employees deserve health care providers that meet the highest standards of ethical and professional behavior,” said Bret Mastronardi, Special Agent in Charge for the Office of Personnel Management – Office of the Inspector General. “Today’s settlement reminds all providers that they must observe those standards, and reflects the OPM-OIG’s commitment to pursuing improper and illegal billings that increase the cost of medical care.”
Northwest ENT has five office locations, operates a single specialty surgery center, and provides services at four hospitals in Georgia. The physicians at Northwest ENT specialize in the medical field of otolaryngology and are commonly referred to as “ear nose and throat” or “ENT” physicians.
Among the procedures that Northwest ENT performed, is the treatment of sinusitis with a “balloon catheter,” which is inserted into the patient’s sinus and inflated by the physician to enlarge the sinus cavity. The balloon catheters that Northwest ENT used was cleared by the U.S. Food and Drug Administration as intended for single use only. Despite this, the physicians at Northwest ENT re-used the devices on their patients, instead of using a new device for each patient. The civil settlement resolves the government’s investigation into these allegations.
The government alleges that Northwest ENT violated the False Claims Act, 31 U.S.C. § 3729, et seq., by causing the submission of false claims to Medicare, TRICARE and Federal Employee Health Benefit Plans for sinus dilation procedures during the period March 1, 2011 through March 30, 2012, in which the single-use balloon catheters were re-used on their patients.
In addition, pursuant to a Non-Prosecution Agreement with the United States, Northwest ENT has accepted responsibility for its actions. It has entered into a three-year Integrity Agreement with the Office of the Inspector General of the Department of Health and Human Services. Under the agreement, an independent organization will review Northwest ENT’s claims quarterly for medical necessity, accurate coding, and safe and appropriate use of medical devices.
This case was investigated by the U.S. Attorney’s Office for the Northern District of Georgia, the U.S. Department of Health and Human Services – Office of Inspector General, the Food and Drug Administration – Office of Criminal Investigations, the Defense Criminal Investigative Service, and the Office of Personnel Management – Office of the Inspector General.
The civil settlement was reached by Assistant U.S. Attorney Neeli Ben-David, Deputy Chief of the Civil Division. The criminal resolution was reached by Assistant U.S. Attorney Randy Chartash.
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Prime care Services, Inc., Prime care Foundation, Inc., and Prime care Management, Inc. (collectively Prime), and Prime’s Founder and Chief exective officer, Dr. Prem Reddy, have united to pay the u. s. $ 65 million to settle allegations that fourteen Prime hospitals in Calif. wittingly submitted false claims to health care by admitting patients World Health Organization needed solely more cost effective, patient care and by asking for costlier patient diagnoses than the patients had (a apply called “up-coding”), the Justice proclaimed these days. below the settlement agreement, Dr. Reddy pays $ 3,250,000 and Prime pays $ 61,750,000.
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Retail giant accused of submitting claims for payment to Minnesota’s Medicaid program in violation of rules. Wal-Mart Stores, Inc. and Sam’s West, Inc. (d/b/a/ Sam’s Club) have agreed to pay a total of $ 825,000 to resolve False Claims violations, according to a May 29 press release from the U.S. Attorney’s Office for the District of Minnesota. […]
AAPC Knowledge Center
US Attorney John H. Durham and CT Attorney General George Jepsen announced that Ellington BEhavioral Health (“EBH”) has entered into a civil settlement agreement with the federal and state governments to pay $ 805,071 to resolve allegations that they violated the federal and state False Claims Acts. The government alleges that EBH submitted claims to Medicare for multiple units of urine drug screening tests when they knew or should have known that only one unit of service could be billed per patient encounter.
The post Ellington Psychiatrist To Pay Over $ 800,000 In False Claims Act Allegations Settlement appeared first on The Coding Network.
The US Attorney’s Office for the Middle District of Pennsylvania announced that Charles Cole Memorial Hospital agreed to pay the United States $ 373,547.54 to settle allegations that they failed to bill under a particular modifier to reduce the Medicare reimbursement amount for services provided by physician assistants and nurse practitioners.
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From Nov. 1, 2007 through Dec. 31, 2016, Banner Health billed Medicare for short-stay, inpatient procedures provided at 12 of its hospitals in Arizona and Colorado that should have been billed on a less costly outpatient basis, and inflated in reports to Medicare the number of hours for which patients received outpatient observation care, according […]
AAPC Knowledge Center
St. Agnes Healthcare in Baltimore, Maryland has agreed to pay the United States a sum of $ 122,928 to resolve issues under the False Claims Act. These allegations allege that they submitted false claims to Medicare by billing for E&M Services at a higher reimbursement rate than the Federal health care programs allowed.
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The Navicent Health Medical Center has agreed to pay $ 2.5 million to settle federal allegations that it submitted bills for ambulance trips that were either medically unnecessary or inflated. The settlement follows a 27-month investigation, which was prompted by a whistleblower.
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