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 […]
The recovery audit contractor (“RAC”) for Region B covering the Midwestern states, CGI Federal, Inc., is requesting additional documentation from providers regarding facet joint injections without reported imaging guidance (CPT codes 64470-64476). The requests for additional documentation acknowledge that CMS has not yet approved this issue for complex review and further acknowledge that the RAC […]
On February 2, 2011, the OIG published its findings from an audit conducted of Prescription Drug Event (PDE) records obtained from Medicare Part D sponsors for Schedule II drugs. A copy of the report can be found at: http://go.usa.gov/Ydd. A significant number of PDE records contained invalid prescriber identifiers which accounted for approximately $20.6 million […]
In an Office of Inspector General (OIG) press release, the OIG announced its first-ever Most Wanted Healthcare Fugitives List, which includes photos and profiles for each fugitive. According to the press release, “the 10 individuals on the Most Wanted Health Care Fugitives List have allegedly cost tax payers more than $124 million in fraud. In […]
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