In Audit
Aug 27th, 2019
The Centers for Medicare & Medicaid Services (CMS) knows that a significant amount of money is being overpaid to insurance companies in the Medicare Advantage program, but they have yet to recover these overpayments. That’s about to change. CMS says it will increase the audits being performed on Medicare Advantage risk-adjusted code submissions and apply ...
In Coding
Jul 23rd, 2019
Bay City, Michigan surgeon Vasso Godiali, MD, was indicted on July 10, 2019, for allegedly orchestrating a $60 million healthcare fraud scheme. He is also charged with money laundering for financial transactions involving almost $50 million in proceeds from the scheme. The indictment comes from both the federal government and Michigan state authorities because it ...
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 ...