Upcoding
This archive displays posts tagged as relevant to upcoding in healthcare billing. You may also be interested in our pages:
March 27, 2019
In the second largest resolution of a Medicaid fraud case based in Washington State, CareOne Dental Corporation and its owners will pay $1 million to settle allegations of violating Washington's Medicaid False Claims Act. According to the AG's office, CareOne and defendants Dr. Liem Do and Dr. Phuong-Oanh Tran defrauded Medicaid by using higher paying codes, masking ineligible services as eligible services, and billing for services the practice didn't even provide. Ultimately, the defendants racked up about $1 million over the course of four years. AG WAFebruary 21, 2019
Hooshang Poor, a doctor of geriatric medicine based in Newton, Massachusetts, has agreed to pay $680,000 to resolve claims under the False Claims Act that he knowingly submitted inflated charges to Medicare and the Massachusetts Medicaid program. Dr. Poor was alleged to submit bills with false procedural codes that overstated the length, extent, and scope of services that he furnished to nursing home residents, and misrepresented services provided by non-physician employees. USAO Mass.Data Whistleblower Case Raises Question of What is a Public Disclosure
Posted 02/21/19
February 14, 2019
Prime Healthcare Services and its CEO Prem Reddy, will pay $1.25 million to settle claims under the False Claims Act that two Prime Healthcare hospitals in Pennsylvania, Roxborough Memorial Hospital and Lower Bucks Hospital, billed Medicare for patients who were admitted when they could have been treated on an outpatient basis, and up-coded patient diagnoses to increase Medicare payments. The investigation was initiated by an anonymous whistleblower identified as a former employee of the Roxborough hospital. USAO ED PAFebruary 7, 2019
Six people associated with a string of substance abuse treatment centers have been indicted for defrauding Ohio's Medicaid program of over $31 million. Ryan Sheridan, the owner and operator of the businesses, along with Jennifer Sheridan, Kortney Gherardi, Lisa Pertee, Thomas Bailey, and Arthur Smith, allegedly submitted claims that were false on a number of fronts, including but not limited to: billing without proper documentation, for medically unnecessary services, provided by unqualified persons, and upcoded to a more costly service. Altogether, 134,744 false claims were submitted for more than $48.5 million in services. USAO NDOHDecember 19, 2018
A vascular surgeon and his practice group, Dr. Irfan Siddiqui and the Heart and Vascular Institute of Florida (HAVI), have agreed to pay $2.23 million to settle a False Claims Act brought by a whistleblower, Lois Hawks, who had been a patient of the doctor. Defendants were alleged to have submitted false claims for vein ablation services that were not medically necessary, were performed by unqualified personnel, or were based on medical records containing false diagnoses and symptoms. In addition, defendants were alleged to have upcoded evaluation and management service claims. Ms. Haws will receive a relator's share of $446,000. USAO MDFLListen: Expected Dismissal of Providence Health Upcoding Suit
Posted 12/7/18
Constantine Cannon partner Mary Inman joins the RAC Monitor “Monitor Monday” podcast to comment on the government’s decision to decline to intervene in a $188.1 million whistleblower lawsuit Med Analytics, LLC filed against Providence Health (now known as Providence St. Joseph) alleging Providence upcoded diagnoses it submitted to government health programs for reimbursement. Several reports have indicated the...