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In a final rule, CMS expands telehealth coverage but enforces budget neutrality mandate. After a slight delay, the Centers for Medicare & Medicaid Services (CMS) has finalized 2021 payments and policies under the Medicare Physician Fee Schedule (PFS). Most notably, the final rule makes permanent several telehealth flexibilities introduced during the public health emergency (PHE) […]
The post Expect Give and Take in 2021 Physician Fee Schedule appeared first on AAPC Knowledge Center.
A Texas physician was found guilty Jan. 15 for his role in a $ 325 million healthcare fraud scheme that involved falsely diagnosing patients with various degenerative diseases and then administering chemotherapy and other toxic drugs to patients based on the false diagnoses, according to the Department of Justice.
After a 25-day trial, Jorge Zamora-Quezada, MD, was convicted of one count of conspiracy to commit healthcare fraud, seven counts of healthcare fraud and one count of conspiracy to obstruct justice.
Dr. Zamora-Quezada was charged in an indictment unsealed in May 2018. In addition to falsely diagnosing patients and administering unneeded drugs, he also allegedly conducted a battery of other fraudulent and excessive medical procedures on patients to increase revenue and fund his opulent lifestyle. Many patients, some as young as 13, suffered physical and emotional harm as a result of the false diagnoses and unnecessary procedures and chemotherapy injections, according to the Justice Department.
Read the full story on Becker’s Hospital Review here.
The post Texas Physician Guilty in $ 325M Fraud Case Involving False Diagnoses appeared first on The Coding Network.
There’s a painful fact about medicine today, one practitioners and healthcare organizations are often hesitant to talk about: Physicians choose to end their lives at a rate of around twice the rest of the general population. Exact numbers are hard to come by because of inaccurate or misleading cause-of-death coding and likely under-reporting. According to […]
The post Healing the Healer: How to Handle Physician Suicide appeared first on AAPC Knowledge Center.
A physician assistant (PA) serves as an assistant surgeon only to suture and close an incision. There is no documentation that the PA performed any other function to assist the primary surgeon during the surgery performed on the Medicare patient, such as providing extra hands needed for tasks which required more than the surgeon’s two […]
The post 2 Tips for Billing a Physician Assistant as Assistant Surgeon appeared first on AAPC Knowledge Center.
On July 29, 2019, the Centers for Medicare Services (CMS) issued a projected rule that has proposals to update payment policies, payment rates, and quality provisions for services equipped beneath the Medicare Physician Fee Schedule (PFS) on or after Jan 1, 2020.
The Calendar Year (CY) 2020 PFS projected rule is one amongst many planned rules that replicate a broader Administration-wide strategy to make a healthcare system that leads to greater accessibility, quality, affordability, direction, and innovation.
The post Proposed Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2020 appeared first on The Coding Network.
Here’s how to fight back. Most of us are concerned about being personally attacked by cybercriminals, and we must have that same increased awareness within our medical practices. Cybercriminals consider medical practices ripe for the picking. Security policies and continuous education work like pesticides. Are you protected from a HIPAA breach? The Name of the […]
The post Cyber Threats to Physician Practices Are Growing appeared first on AAPC Knowledge Center.
On December 20, 2018, Michael Jadali, D.O., and the Center for Pain & Rehabilitation Medicine (collectively, “Dr. Jadali”), San Jose, California, entered into a $ 60,406.30 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Jadali submitted claims to Medicare for Healthcare Common Procedure Coding System codes 80500 (clinical pathology consultation; limited, without review of patient’s history and medical records) and 80502 (clinical pathology consultation, comprehensive, for a complex diagnostic problem, with review of patient’s history and medical records), where no consultation request had been made, no written narrative report by a consultant pathologist was produced, and no exercise of medical judgement by a consultant pathologist was required. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
The post California Physician and Practice Settle Case Involving False Claims 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.
A former owner and medical director of a Baton Rouge pain management clinic was sentenced to over 3 years in federal jail Friday during a health care fraud scheme, federal authorities mentioned. Dr. John Eastham Clark, who co-owned Louisiana Spine & Sports on Bluebonnet avenue, additionally was ordered to pay nearly $ 255,000 in restitution by Chief U.S. District judge Shelly Dick.
The post Baton Rouge Physician sentenced to over three years in jail in a fraud scheme appeared first on The Coding Network.