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Private health data was exposed through third-party tracking technology. Advocate Aurora Health recently notified the U.S. Department of Health and Human Services Office for Civil Rights that it experienced a data breach on October 14. Advocate Aurora Health is a 26-hospital healthcare system in Wisconsin and Illinois with over 500 sites of care and $ 14 […]
The post Advocate Aurora Health Data Breach Affects 3 Million Patients 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.
Neurosurgeon Medical Practice Director to Pay Over $ 1 Million
Neurosurgeon Medical Practice Director to Pay Over $ 1 Million to Resolve False Claims Act Liability Arising from Billing of P-Stim Devices. PHILADELPHIA – First Assistant United States Attorney Jennifer Arbittier Williams announced that neurosurgeon Sagi M. Kuznits, practice director Pnina Kuznits, and Neurosurgical Care LLC (collectively, “Kuznits”), have agreed to pay $ 1,017,375.03 to resolve liability under the False Claims Act for the alleged improper billing of electro-acupuncture devices called Stivax and/or P-Stim and a memory-loss device called eVox.
From February 2017 through July 2018, Kuznits billed Medicare, TRICARE, and the Federal Employees Health Benefit Program for the implantation of neuro-stimulators – a surgical procedure which usually requires an operating room and which is reimbursed by federal healthcare programs – when in fact the only procedures performed had been the non-surgical application of P-Stim and Stivax by a physician assistant.
In addition, Kuznits billed Medicare for a physician assistant’s application of an “eVox” device.
“We continue to work closely with our partners at CMS’s Center for Program Integrity, the Department of Health and Human Services Office of Inspector General, other federal healthcare programs, state partners, and sister U.S. Attorney’s Offices around the country to hold accountable any other providers who inappropriately billed this device and any product distributors or marketers who may have devised or carried out such a billing scheme,” stated First Assistant U.S. Attorney Williams.
“We thank our partners at the Department of Justice and Department of Health and Human Services Office of Inspector General for working hard with us to identify, investigate, and eliminate waste, fraud and abuse in our federal healthcare programs.”
“Accurately billing for services provided to Medicare beneficiaries is required of all health care providers,” said Maureen R. Dixon, Special Agent in Charge for the U.S. Department of Health and Human Services, Office of the Inspector General.
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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.
A Greensboro-based medical transport company was sentenced in court for health care fraud after pleading guilty to one count of health care fraud in October 2018, according to US Attorney lawyer Matthew G.T. Martin of the District of North Carolina. The company in question, Gate City Transportation, was ordered to pay a $ 100 fine, a $ 400 penalty tax, and restitution over five million. The funds would go, in their entirety, to the N.C. Fund for Medical Assistance. The verdict and penalty was handed down by US District Court Judge Loretta “Copeland” Biggs of the District of North Carolina.
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Beaver Medical Group L.P. (BMG) and a doctor who works for it, Dr. Sherif Khalil, have agreed to pay a little over the amount of $ 5 million to resolve accusations that they falsely reported diagnosis codes to plans of Medicare Advantage, thereby causing said plans to receive inflated payments. BMG is headquartered in Redlands, CA. “The United States relies on healthcare providers to submit accurate diagnosis data to Medicare Advantage plans to ensure those plans receive the appropriate compensation,” said Jody Hunt, Assistant Attorney General of the DOJ’s Civil Division. “We will pursue those who undermine the integrity of the Medicare program and the data it relies upon.”
The post Medicare Advantage Supplier and Doctor to Pay $ 5 Million to Settle False Claims Act Allegations appeared first on The Coding Network.
Separately asking routine evaluation and management (E/M) services provided on a similar day as another procedure is usually denied by Medicare. Care providers might typically individually bill E/M services if they meet certain criteria and append modifier 25 vital, on an individual basis specifiable analysis and management service by a similar MD or different qualified health care skilled on a similar day of the procedure or different service to the claim. Modifier twenty five shows payers, like Medicare, that a care supplier went higher than and on the far side the standard E/M of pre-operative and post-operative care related to the medical procedure; which it had been vital, on an individual basis specifiable service. If this modifier gets used, a supplier unbundles a service and receives further compensation ― overpayments of Medicare bucks. Per a whistleblower, this is what Skyline urology allegedly did between January. 1, 2013 and Dec. 31, 2016.
The post $ 1.85 Million Paid to Settle Urology Modifier 25 Whistleblower Case appeared first on The Coding Network.
A United States Federal Jury found Dr. Robert Glazer guilty on June 7th for his primary role during a 33 million dollar fraud scheme concerning requests of Medicare for care services that were not actually provided. Following a seven-day trial, Dr. Glazer was found guilty of a single count of Conspiracy to Commit Fraud and twelve separate counts of actual Health Care Fraud.
Click Here to Read the Full Story!
The post Los Angeles Doctor Condemned In 33 Million Dollar Fraud Scheme appeared first on The Coding Network.
Joseph P. Galichia MD, the previous owner of the Wichita-based Galichia Medical, after quite some time, reached Fraud Claim Act settlements with the Feds in 2000 and 2009 amounting to nearly 6 Million Dollars. This was his third time settling with the US Federal Government for such behavior.
Click Here to Read the Full Story!
The post Kansas Doctor Forks Over Almost 6 Million in Settling 3rd False Claims Case in Twenty Years appeared first on The Coding Network.
A LA, California-based dental practitioner was sentenced to forty months in jail last week for his role during a $ 3.8 million health care fraud scheme during which he charged various dental insurance carriers for crowns and fillings that were not ever actually provided to patients. Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. attorney Nicola T. Hanna of the Central District of CA, Acting Assistant Director responsible for John P. Selleck of the FBI’s Washington, D.C. Field workplace and Assistant Director accountable for Paul D. Delacourt of the FBI’s LA Field workplace generated the announcement.
The post Los Angeles Dental Practitioner Sentenced to Forty Months in Jail for Role in $ 3.8 Million Health Care Fraud Scheme appeared first on The Coding Network.