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 ...
May 13th, 2016
Exit interviews are scheduled interviews conducted with departing employees. Human resource departments have been performing these interviews for years to gauge what the company is doing well, to ensure company assets are accounted for, and to identify areas where the organization can improve. But, exit interviews are not just beneficial from a human resources perspective. ...
Jan 26th, 2016
Two recent cases from Georgia demonstrate that organizations must not ignore—and certainly shouldn’t fire (as a knee-jerk reaction)—employees who raise compliance concerns and who are protected by the False Claims Act (FCA). In one case, HCA Holdings, Inc., (HCA) the largest operator of healthcare facilities in the United States, entered into an agreement with the ...
In Audit
Sep 15th, 2015
by John Verhovshek, MA, CPC What should you do if you are expected to code in a way that you suspect is abusive, or even fraudulent? First—before you take any action—be clear about what is being asked of you. Misunderstandings happen, and you don’t want to make accusations that you’ll later regret. Next, research your ...
Jun 3rd, 2015
by John Verhovshek The Supreme Court has ruled that the False Claims Act allows for multiple qui tam actions—or “whistleblower” suits—based on a single complaint. The unanimous decision in Kellogg, Brown & Root Services Inc. v. United States ex. rel. Carter, announced May 26, removed any assumption that “first to file” prevents subsequent suits based ...