South Florida has been called the “national epicenter” for the illegal dispensing of prescription drugs. Law enforcement officials have targeted South Florida for quite some time, with February 23 being no exception. On February 23, law enforcement officials and Drug Enforcement Agency (DEA) agents raided six pain clinics accused of illegally dispensing prescription drugs, arresting […]
In a report issued last week, the Centers for Medicare and Medicaid Services (CMS) states that National Government Services, Inc. (NGS), the durable medical equipment (DME) Medicare administrative contractor for Jurisdiction B, inappropriately permitted $56.2 million in claims for CY 2007 for home blood-glucose test strips and/or lancet supplies used for diabetics. Of this $56.2 […]
In its first civil monetary penalty issued for a covered entity’s violation of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, the Department of Health and Human Services (HHS), through its Office of Civil Rights (OCR), imposed a $4.3 million penalty on Cignet Health of Prince George’s County, Maryland (Cignet) in its Notice […]
Empire Blue Cross Blue Shield of New York, serving about 5 million members, is now instituting a pay-for-performance program that rewards physicians with greater reimbursement for complying with certain best practices. The aim is to encourage physicians to adopt best practices, so those who do not meet the standards will not be penalized. The factors […]
On Wednesday, February 16, the House Judiciary Committee approved a medical liability reform bill that would limit a plaintiff’s non-economic damages to $250,000. This vote comes at a time when tort reform has been in the spotlight as President Obama’s fiscal 2012 budget proposal included $250 million in grants over the next three years to […]
Over $225 million in false billing, 111 defendants, and 9 cities across the country. The Medicare Fraud Strike Force charged doctors, nurses, physical and occupational therapists, healthcare company owners and executives and others in the largest Medicare fraud takedown ever. The defendants are accused of various healthcare fraud-related crimes, including conspiracy to defraud Medicare, criminal […]
The 38-count indictment charged 20 individuals with various healthcare fraud, kickback and money laundering charges related to their alleged participation in a healthcare fraud scheme involving approximately $200 million in Medicare billing for mental health services. The defendants worked with and for American Therapeutic Corporation (ATC) and Medlink Professional Management Group Inc. allegedly submitting false […]
Elizabeth L. Johnson, a former New York pharmacist was charged with grand larceny, offering a false instrument for filing and unauthorized practice for her allegations that she defrauded Medicaid out of approximately $191,000. While Johnson’s license to practice as a pharmacist was suspended and she was excluded from participating in Medicaid, she allegedly continued to […]
Today, the Office of Inspector General (OIG) released supplemental materials for its Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud and Abuse, which include a companion PowerPoint presentation, a speaker note set to assist in presenting the PowerPoint presentation and a narration of the speaker’s notes. All of these resources can be found at […]
Wisconsin Physician Services (“WPS”), the Medicare Part B Carrier for providers in Michigan, Illinois, Minnesota and Wisconsin, recently conducted a service-specific probe review of Current Procedural Terminology (“CPT”) 99233 billed by neurology providers. WPS found that only 4 percent of billed claims were payable. 96 percent were denied or down-coded. CPT 99233 is a hospital […]
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