Medicare Compliance & Reimbursement

Just because you provide services for inmates, that doesn't mean you too can break the law.

After years of attention from the HHS Office of Inspector General, companies that provide inmate health services may have the heat turned up on their billing practices more than ever.
 
Investigators in Florida held one company's feet to the fire -- and emerged with a $5 million dollar Medicaid fraud settlement, Attorney General Charlie Crist said March 31.

EMSA Limited Partnership, which contracted with government agencies for prison medical services, allegedly skirted state and federal laws by encouraging providers to illegally submit claims for services provided to inmates. According to prosecutors, between 1998 and 2004, EMSA directed beneficiary ID numbers to be given to providers and billed to Medicaid when inmates were sent to outside hospitals, and also to pharmacies for prescriptions given while the patient was incarcerated.

EMSA, whose $5 million pay-out includes $1 million in penalties, fully cooperated in the investigation and "remains duly qualified to do business in the state of Florida," according to the AG's office.

Lesson Learned: Oversight in the billing department is a must for all companies.