In Audit
Mar 5th, 2019
Separately billing routine evaluation and management (E/M) services provided on the same day as another medical procedure is typically denied by Medicare. Healthcare providers may sometimes separately bill E/M services if they meet certain criteria and append modifier 25 Significant, separately identifiable evaluation and management service by the same physician or other qualified health care ...
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 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 ...
Jun 1st, 2017
eClinicalWorks (ECW), located in Westborough, Mass., has agreed to pay $155 million to avoid prosecution for alleged False Claims Act violations. The U.S. Department of Justice (DOJ) accused ECW of misrepresenting the capabilities of its electronic health record (EHR) software and paying kickbacks to certain customers in exchange for promoting its product. The DOJ contends that ...
Before you blow the whistle, know your options and understand the consequences. In March 2014, on the eve of trial, Halifax Health — a 678-bed public hospital system in Daytona Beach, Florida — agreed to pay $85 million to settle allegations that it had violated the Stark physician referral law and submitted False Claims to ...