United States Settles False Claims Act Allegations Against Orthopedic Surgery Practice For $4,488,000

A Florida orthopedic office has agreed to pay $4.4 million in medicare fraud claims.  This recoupment is for all the things we frequently uncover as outside auditors:  “incident to” billing errors, modifier misuse, bundled services billed in global periods, and lack of medical necessity documented.  Compliance services such as MyMeducator.com staff e-learning programs, external chart audits, and outside compliance specialists like HMCExperts.com would have uncovered these ...

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Dermatologists are high on the DOJ and CMS investigations this year as they worked to recover more than $2.5 billion in Medicare fraud cases.

MOHS services targeted for audit in 2019.  Dermatologists are high on the DOJ and CMS investigations this year as they worked to recover more than $2.5 billion in Medicare fraud cases. Compliance services such as MyMeducator.com staff e-learning programs, external chart audits, and outside compliance specialists like HMCExperts.com have helped many providers avoid these costly mistakes.

 

The US Department of Justice (DOJ) and the Centers for ...

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Justice Dept Recovered $2.5B from Healthcare False Claims in 2018

2018 HEALTHCARE TAKEDOWN

By the numbers

601 Defendants charged, including:

165 Medical Professionals

$2.5 billion in Losses

587 Exclusions Issued

58 Federal Districts

30 Fraud Control Units

350 OID Agents

 

2018 healthcare fraud settlements exceed $2 billion dollars for the 9th consecutive year.  Compliance services such as MyMeducator.com staff e-learning programs, external chart audits, and outside compliance specialists like HMCExperts.com Continue Reading →

Cut IPPE denials with a concerted focus on CMS’ 7-pronged requirements (May 2017)

By Richard Scott (Belinda Holmes as Contributor)

in May 1, 2017 Part B News: Patient Encounters

Focus more on the preventive aspects of the “Welcome to Medicare” visit instead of the physical exam components and you may steer your practice to more success with this oft-denied service.

Practices endured a 17% denial rate for G0402 (Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment) in 2015, the latest year of available Medicare claims data. The ...

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Medicare Uses Big Data to Fight Fraud (Feb. 2017)

Medicare Employs Sophisticated Data Analytics to Catch $1.5 Billion in Fraud 

 

The latest in Medicare and Medicaid fraud prevention? A collaboration between the Centers for Medicare & Medicaid Services (CMS), predictive analytic technology, and big data that has contributed to more than $1 billion in savings in 2014 and 2015.

The Fraud Prevention System (FPS) is a proactive strategy that analyzes payment requests submitted by providers. By looking at 4.5 million Medicare claims made on a daily basis, it aims to prevent ...

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Attestation for 2016 MU & PQRS Now Open (Jan. 2016)

Attest to 2016 Program Requirements by February 28, 2017

The Centers for Medicare & Medicaid Services Registration and Attestation System is now open. Providers participating in the Medicare EHR Incentive Program must attest to the 2016 program requirements by February 28, 2017 at 11:59 p.m. ET in order to avoid a 2018 payment adjustment. The EHR reporting period was any continuous 90 days between January 1 and December 31, 2016.

If you are participating in the ...

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