Contact

Click here for a confidential contact or call:

1-212-350-2764

Upcoding

This archive displays posts tagged as relevant to upcoding in healthcare billing. You may also be interested in our pages:

Page 4 of 8

May 14, 2018

Missouri-based podiatry provider Foot Healers agreed to pay the United States $125,000 to settle allegations the company violated the False Claims Act by using improper billing modifiers to inflate Medicare claims and falsely upcoding routine toenail trimmings performed on Medicare patients by claiming the service provided was medically necessary toenail debridement. USAO EDMO

May 14, 2018

Houston-based healthcare provider Memorial Hermann Health System agreed to pay nearly $2 million to resolve allegations it admitted Medicare patients for surgical procedures to three company-owned hospitals, then fraudulently billed for the services provided to these patients at inpatient rates when it should have billed at lower outpatient rates. USAO SDTX

May 4, 2018

New York City-based urgent care company CityMD agreed to pay roughly $6.6 million to settle claims it violated the False Claims Act by billing Medicare for services rendered by physicians who did not actually perform those services and for more expensive and complex services than were actually provided to patients. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. DOJ

April 27, 2018

Las Vegas medical practice Cardiovascular and Thoracic Surgeons of Nevada, Inc. agreed to pay $1.5 million to resolve allegations it violated the False Claims Act by billing federal healthcare programs for surgical services not actually provided to its cardiac patients and billing for more expensive surgical and evaluation and management services than actually provided. DOJ (NV)

New York Urgent Care Clinic Pays Over $6.6M to Settle FCA Suit

Posted  05/7/18
By the C|C Whistleblower Lawyer Team CityMD, a company that manages over 80 urgent care clinics in and around New York City, has settled allegations that it billed Medicare for more expensive services than were actually performed, and that it billed Medicare under the names of doctors who did not actually perform the services. Under the terms of the settlement, CityMD also accepted responsibility for its...

April 10, 2018

Connecticut-based medical practice World Health Clinicians, Inc., its CEO Scott Gretz, and former World Health physician Gary Blick agreed to pay roughly $650,000 to settle claims they violated the False Claims Act by submitting claims for physical therapy and other covered services when in fact the patients received massages provided by a massage therapist. DOJ (CT)

April 5, 2018

The Estate of Dr. Leroy Pelicci, former owner of Scranton-based Pelicci Pain Relief Center, agreed to pay $625,000 to settle claims he violated the False Claims Act by submitting improper claims for payment to the Department of Labor Office of Workers’ Compensation Programs under the Federal Employees Compensation Act and the Federal Employees Health Benefits Program for trigger point injections, which were upcoded to receive a higher reimbursement amount than permitted. DOJ (MDPA)

March 29, 2018

Louisville-based skilled nursing facility New Oaklawn Investments, LLC (d/b/a Oaklawn Health and Rehabilitation Center and Elmcroft Senior Living, Inc.) agreed to pay roughly $5 million to resolve allegations it violated the False Claims Act by submitting false claims to Medicare for patient rehabilitation services at the resource utilization (“RUG”) Code Series Rehabilitation Ultra High and Rehabilitation Very High, for certain services that were not reasonably or medically necessary. DOJ (WDKY)

March 27, 2018

Iowa acute care hospital Genesis Medical Center agreed to pay $1.88 million to settle claims it violated the False Claims Act by improperly retaining Medicare overpayments for hospital inpatient admission claims when those claims should have been billed at the lower reimbursement rate for either outpatient or observation services. DOJ (SDIA)

January 24, 2018

Tennessee chiropractor Matthew Anderson agreed to pay $1.45 million to resolve allegations he violated the False Claims Act. Specifically, the government alleged that Anderson and his management company, PMC LLC, caused pharmacies to submit requests for Medicare and TennCare payments for pain killers dispensed based upon prescriptions written at the Cookeville Center for Pain Management, one of the pain clinics Anderson managed, which had no legitimate medical purpose. The government further alleged that Anderson caused four pain clinics he managed to bill Medicare for upcoded claims for office visits that were not reimbursable at the levels sought. The allegations originated in a whistleblower lawsuit filed by a former office manager for the Cookeville Center for Pain Management under the qui tam provisions of the False Claims Act. The whistleblower will receive a whistleblower award of $246,500 from the proceeds of the government's recovery. DOJ
1 2 3 4 5 6 8

Newsletter

Subscribe to receive email updates from the Constantine Cannon blogs

Sign up for: