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Respironics to pay over $ 24 million in kickbacks scheme. Maryland, other states, and the federal government have reached a settlement with Philips RS North America LLC on behalf of Respironics, a subsidiary to resolve alleged false claims. The durable medical equipment (DME) manufacturer of devices such as ventilators, oxygen concentrators, CPAP and BiPAP machines, and […]
The post DME Manufacturer Settles in Alleged False Claims Act Violation appeared first on AAPC Knowledge Center.
Don’t let avoidable errors muck up your revenue cycle. A clean claim is one that does not require the payer to investigate or develop the claim before it can fully process it. The claim is received on time, passes all edits, is appended with any required medical evidence and supporting documentation, and includes all the […]
The post 10 Tips for Clean Claims appeared first on AAPC Knowledge Center.
The blood test distributor agrees to pay $ 195,000 to settle allegations that it violated the FCA. The U.S. Department of Health and Human Services Office of Inspector General (OIG) lately conducted an investigation into False Claims Act (FCA) violations by GlycoMark, Inc. The OIG alleges that GlycoMark encouraged providers to submit claims for its hyperglycemia […]
The post GlycoMark Settles False Claims Act Allegations appeared first on AAPC Knowledge Center.
Billing consultant implicated in healthcare provider’s wrongdoing. Can I be prosecuted for fraud because of my involvement in submitting a false claim? This is a common question from coding and billing personnel, especially when they have concerns regarding the codes and modifiers they are directed to bill relative to provided healthcare services and supplies. While […]
The post FCA Settlement Clarifies False Claims Liability for Consultants appeared first on AAPC Knowledge Center.
Code updates prompted the release of Change Request (CR) 12377 by the Centers for Medicare & Medicaid Services (CMS) on Oct. 13. The updates to chapters 3, 18, and 32 of the Medicare Claims Processing Manual Pub. 100-04 are effective Nov. 17, 2021. CR12377 further clarifies that “Unless otherwise specified, the effective date is the […]
The post CR12377 Updates Coding in Medicare Claims Processing Manual appeared first on AAPC Knowledge Center.
A recent audit on Arkansas MMIS private contractor costs reveals millions in incorrect claims and inappropriate payments. Last month the Office of Inspector General (OIG) conducted an audit to determine whether Arkansas followed applicable federal and state requirements related to procuring private Medicaid Management Information System (MMIS) contractor services and claiming federal Medicaid reimbursement. They […]
The post OIG Discovers $ 4.4 Million Overpayment in State Claims appeared first on AAPC Knowledge Center.
If your provider furnishes Medicare patients with any of the services or supplies on this list, expect an ADR. Ever wish you had a crystal ball to foresee when a Recovery Audit Contractor (RAC) might send your office an Additional Documentation Request (ADR) letter? Luckily, all you really need is the World Wide Web; RACs […]
The post 10 Service/Supply Claims Under Review appeared first on AAPC Knowledge Center.
Illinois Physician Settles Case Involving False Claims
The settlement agreement resolves allegations that Dr. Tolitano submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 93965, when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which Dr. Tolitano submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service.
The post Illinois Physician Settles Case Involving False Claims appeared first on The Coding Network.
Texas Physician and Practice Settle Case Involving False Claims
The settlement agreement resolves allegations that Dr. Robbins submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 93965, when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which Dr. Robbins submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service.
The post Texas Physician and Practice Settle Case Involving False Claims appeared first on The Coding Network.
New Mexico Physician and Practice Settle Case Involving False Claims
The settlement agreement resolves allegations that Dr. Reddy submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 93965, when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which Dr. Reddy submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service.
The post New Mexico Physician and Practice Settle Case Involving False Claims appeared first on The Coding Network.