HEALTHCON 2019 (April 28-May 1 in Las Vegas) is for everyone on the business side of healthcare, and provides cutting-edge education, networking, and other opportunities to attendees. Expert speakers, such as Office of Inspector General (OIG) Special Agent Tony Maffei, help make this a professional event you can’t miss. AAPC asked Maffei about his presentation, ...
In CMS
Jan 21st, 2019
Intermountain Healthcare wants the Supreme Court to weigh in on if the False Claims Act’s (FCA) provisions for whistleblowers violates the Constitution. This could affect compliance efforts across healthcare. Medical Judgment No FCA Sanctuary The issue arose last summer when the US Court of Appeals for the Tenth Circuit ruled that medical judgment can’t be ...
In CMS
Nov 14th, 2018
Another opioid pill mill gets busted by the Medicare Fraud Strike Force. A “pain management clinic” in Hialeah, Florida, owned by David Bosch and Tania Sanchez, which operated under the name East Medical Office Inc., unlawfully distributed thousands of pills of oxycodone, during the period of April 2017-May 2018. It was a cash-only clinic, which remained ...
In CMS
Oct 30th, 2018
Thousands of consumers’ files in the Federally Facilitated Exchanges (FFE’s) Direct Enrollment pathway may have been compromised. The Centers for Medicare & Medicaid Services (CMS) said “anomalous activity” was detected in the portal on Oct. 13 and a breach was declared on Oct. 16. CMS issued a press release on Oct. 19. “At this time,” ...
In Billing
Sep 28th, 2018
Health Management Associates, LLC (HMA), a hospital chain that has its headquarters in Naples, Florida will be paying over $260 million to avoid criminal and civil claims associated with a scheme to defraud the government of the United States. In this case, the government alleged that HMA was billing inpatient services when they should have ...