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Audit Hot Spot: When HCPCS Coding Confusion Leads to Overpayments
Here’s where your electronic billing system may be grabbing overpayments by mistake. At first glance, they don’t look like much — two recent OIG reports, one examining oxaliplatin billing from a Seattle facility, and
Continue reading...Internal Auditor Turns Whistleblower at Cardiology Practice
4. January 2010
Upcoding E/M services at heart of the case An internal auditor turned whistleblower when she felt a Michigan cardiology practice was ignoring her concerns about evaluation & management upcoding. A $669,413 settlement with the Department of Justice is the end result.…
Continue reading...Latest on Home Health Fraud Busts
7. December 2009
76K for “vacation pay?” Where can we get a gig like that? Recent fraud busts are threatening home care providers with a bad reputation. In Memphis, an owner of a 30-year-old home health agency was sentenced to 18 months in…
Continue reading...Former HealthSouth Exec Must Do Time, Appeals Court Says
23. November 2009
$41K a day to maintain Scrushy’s yacht — plus other tidbits from the compliance case that just won’t die. Former HealthSouth Chief Information Officer Kenneth Livesay should go to prison for his role in HealthSouth’s now-legendary $2.7 billion accounting fraud that…
Continue reading...DOJ: 2 SNF Chains & Their Principles Named In Omnicare, Risperdal Complaint
9. November 2009
At issue: The antipsychotic drug Risperdal & fair market value. Last week, the Department of Justice announced that nation’s largest nursing home pharmacy, Omnicare Inc., will pay $98 million to settle False Claims Act allegations. IVAX Pharmaceuticals (now a subsidiary of…
Continue reading...‘Sub-Standard Care’ the Crux of Medicaid FCA Case
9. November 2009
Therapists formerly employed at a residential treatment center blow the whistle. Many times, False Claims Act cases in health care hinge on the fact that claims were submitted to Medicare or Medicaid when no actual care was provided at all.…
Continue reading...How One Hospital’s Physician Gifts Ran Afoul of Stark
12. October 2009
One lesson learned: A central tracking system can flag multiple gifts. Your hospital can learn a lot from the mistakes of others, especially when it comes to the slippery Stark rules. On June 26, 2009, the…
Continue reading...Some Flowers & Some PHI
21. September 2009
Some cute stuffed animals, some balloons, some bows, and some sweet bouquets. When you think ‘hospital gift shop’ you don’t usually think about PHI leaks and HIPAA risks. Bounty Coupan Here’s how one respected health system accidentally breached PHI last…
Continue reading...PT Pleads Guilty to Falsifying Medicare Claims
8. September 2009
A Detroit-area physical therapist (PT) has learned the hard way that fraudulently billing Medicare will eventually catch up with you. According to an Aug. 26 press release from the FBI’s Detroit office, the PT pleaded…
Continue reading...For Newspapers, Health Fraud Busts Are Good Scoop
25. August 2009
Tales of health care fraud still doesn’t intrigue the masses like stories of how Jon & Kate will share their 8, but they’re gaining some fans. Used to be only providers and attorneys kept up with the bust gossip, but…
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25. February 2010
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