Aug 1st, 2010
Understand the risks if you miscode. By Michelle A. Dick When claims for provider services aren’t coded and billed properly, financial liability often falls on the provider. What happens when the coder or biller is to blame for sloppy coding or claims processing? Do coders need to pay? Individual Liability for Fraudulent Billing The Federal ...
In Audit
Apr 30th, 2010
More scrutiny of new health care reform (HCR) laws bodes well for coders, to whom physicians will turn to help them avoid expansion of the government’s reach under the federal False Claims Act (FCA), according to an amednews.com report. Experts recommend physicians turn to coders to regularly analyze claims. Expansion of False Claims Review Bodes Well for ...
In CMS
Feb 25th, 2010
Budget cuts in education and compliance programs may be penny wise but dollar foolish. By Michael D. Miscoe, JD, CPC, CASCC, CUC, CHCC Under the False Claims Act (FCA), a health care facility or entity may be held liable for the conduct of its individual employees, or even the conduct of other entities with which ...
Jun 1st, 2009
Medicare’s way isn’t always the right way. By Michael D. Miscoe, JD, CPC, CASCC, CUC, CHCC There is an old adage that if you are right with Medicare, you are right with the rest of the (payer) world. Although such a universal truth would make both coders’ and auditors’ jobs much easier, it simply isn’t ...
Nov 5th, 2008
A recent U.S. Supreme Court ruling re-affirms liability under the federal False Claims Act (FCA) regardless of whether the person causing the submission of false claims to the government financially benefitted from their actions. The ruling denied a petition requesting the review of an appeal’s court decision to allow a Qui Tam suit against state ...