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Two Texas medical practices to pay more than $ 500,000. The attorney for the Western District of Texas has announced separate civil settlements totaling $ 513,168.10 to resolve allegations that two area medical practices violated the False Claims Act (FCA) by improperly billing Medicare for P-Stim devices. Medicare does not pay for acupuncture or acupuncture devices like […]
The post FCA Violation Settled for Fraudulent Billing of P-Stim Devices appeared first on AAPC Knowledge Center.
Healthcare provider pays for billing Medicare before services were fully performed. In U.S. ex rel. Montcrieff v. Peripheral Vascular Associates, 2023 WL 139319 (W.D. Tex. 2023), the court indicated it will award a minimum of $ 24 million in total damages, fines, penalties, and sanctions based upon a medical practice’s purported violation of the False Claims […]
The post A Case of Fraudulent Billing or Common Practice? appeared first on AAPC Knowledge Center.
The US Attorney for Manhattan, New York, and a Special Agent for the OIG’s New York Regional Office, announced today that the US Federal Government has settled a civil fraud suit against Lenox Hill (a Manhattan Hospital) and its corporate parent Northwell. The Government’s complaint alleges that the two Defendants violated the False Claims Act by knowingly and fraudulently billing Medicare for healthcare services that didn’t comply with Medicare law.
The post Lenox Hill Hospital Pays $ 12.3 Million Settlement For Submitting Fraudulent Medicare Claims appeared first on The Coding Network.
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 known were not provided as claimed and were false or fraudulent. Specifically, OIG contended that Miami Urogynecology Center submitted claims for: (1) diagnostic electromyography services using CPT code 51784 when therapeutic, not diagnostic, services had been provided; (2) pelvic floor physical therapy services using CPT codes 97032 and 97110 when those services were provided by an unqualified individual; and (3) evaluation and management (E&M) services using CPT codes 99213 and 99214 that were billed in conjunction with pelvic floor therapy procedures when no separate and identifiable E&M services were provided. OIG’s Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsels Srishti Sheffner and Michael Torrisi, with the assistance of Program Analyst Mariel Filtz, collaborated to achieve this settlement.
The post Florida Physicians and Practice Settle False and Fraudulent Claims Case appeared first on The Coding Network.
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 claimed and were false or fraudulent. Specifically, OIG contended that CWC submitted claims for: (1) diagnostic electromyography services using CPT Code 51784 and diagnostic anorectal manometry (ARM) services using CPT Code 91122 when therapeutic, not diagnostic services, had been provided; (2) ARM services using CPT Code 91122 that were not performed according to CMS guidelines; (3) pelvic floor electrical stimulation that was not preceded by a four-week course of failed pelvic muscle exercise training; and (4) in 13 instances, evaluation and management services using CPT Code 99214 that did not meet the criteria for billing under that code. OIG’s Division of Data Analytics and Office of Counsel to the Inspector General, represented by Senior Counsels David Traskey and Michael Torrisi, with the assistance of Program Analyst Mariel Filtz, collaborated to achieve this settlement.
The post California Physician and Practice Settle False and Fraudulent Claims Case appeared first on The Coding Network.
Nevada Attorney General Aaron D. Passage declared that Moving Forward Counseling Solutions, LLC (Moving Forward), a Medicaid supplier business based out of Las Vegas, was condemned for Medicaid extortion. The misrepresentation was submitted between January 2016 and December 2016.
The post Lawyer General Ford Announces Sentencing of Fraudulent Medicaid Provider Business appeared first on The Coding Network.
On June 11, 2018, James S. Dunn, Jr., MD, d/b/a Auburn Urogynecology and Women’s Health (collectively, “Dr. Dunn”), Auburn, California, entered into a $ 419,578 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Dunn submitted claims to Medicare for items or services that he knew or should have known were not provided as claimed or were false or fraudulent. Specifically, OIG contended that Dr. Dunn submitted claims for:
It was reported that the OIG’s Consolidated Data Analysis Center collaborated on this settlement which might mean the issues were identified through data analytics.
Compliance officers reading these summaries can see how implementing some of the best practices of an effective compliance program might have been able to prevent these problems. For example, regular performance of exclusion checks might have identified the excluded individuals employed by some of the organizations which some of the billing and claims issues might have been identifiable through regular auditing and monitoring programs.
The post California Physician and Practice Settle False and Fraudulent Claims Case appeared first on The Coding Network.
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.
The post Federal government reclaims $ 3.3B+ in fraudulent healthcare claims appeared first on The Coding Network.