In Audit
May 30th, 2018
Retail giant accused of submitting claims for payment to Minnesota’s Medicaid program in violation of rules. Wal-Mart Stores, Inc. and Sam’s West, Inc. (d/b/a/ Sam’s Club) have agreed to pay a total of $825,000 to resolve False Claims violations, according to a May 29 press release from the U.S. Attorney’s Office for the District of Minnesota. ...
In Billing
May 4th, 2018
From Nov. 1, 2007 through Dec. 31, 2016, Banner Health billed Medicare for short-stay, inpatient procedures provided at 12 of its hospitals in Arizona and Colorado that should have been billed on a less costly outpatient basis, and inflated in reports to Medicare the number of hours for which patients received outpatient observation care, according ...
In Billing
Dec 22nd, 2017
The Office of Inspector General (OIG) was busy in 2017. In the video, Eye on Oversight – 2017 Year in Review, released Dec. 20, the agency charged with protecting the integrity of U.S. Department of Health and Human Services (HHS) healthcare programs reflects on its accomplishments throughout the year. Summarizing the video, the OIG reports for ...
Minimizing risk is not just about having a compliance program, there are many other factors to account for. By Joette Derricks, MPA, FACMPE, CPC, CHC, CSSGB A compliance program that only incorporates the seven elements of an effective compliance program (as articulated in the U.S. Sentencing Commission Guidelines Manual) won’t win you bonus points when ...
In Audit
Jul 10th, 2017
A Detroit-area medical biller was recently sentenced to 50 months in prison for helping with a $7.3 million Medicare and Medicaid fraud scheme where services were billed but not rendered. Dawn Bentley, 56, of Oakland County, Michigan, was also ordered to pay $3,253,107 in restitution with her co-defendants for one count of conspiracy to commit ...