Catch of the Week — Health Management Associates
Posted 09/27/18
Upcoding
This archive displays posts tagged as relevant to upcoding in healthcare billing. You may also be interested in our pages:
September 26, 2018
A Connecticut-based doctor, Helar Campos, has agreed to pay $99,912 to settle claims of violating the False Claims Act. The alleged fraud occurred over a span of three years from 2009 to 2012 and involved upcoding claims for doctor visits to Medicare and Medicaid. USAO CTInman writes on whistleblower case brought by outsider
Posted 08/30/18
Integra Med Analytics Files Whistleblower Lawsuit against Providence Health & Services and J.A. Thomas and Associates
Posted 08/30/18
London whistleblower attorney Mary Inman published in RAC Monitor (August 30, 2018). Click here to read the article.
August 28, 2018
Dermatology Healthcare will pay $4 Million to settle allegations of healthcare fraud which violate the False Claims Act. Dermatology Healthcare submitted false claims in order to be paid millions in Medicare and Medicaid reimbursements for treatment of non-melanoma skin cancer during which superficial radiation therapy is administered. It is alleged that the superficial radiation therapy was not properly supervised during treatment and that other procedures in relation to superficial radiation therapy were up-coded. It is further alleged that the radiation simulations were overly used. This settlement is the conclusion of a lawsuit filed by dermatologist Theodore A. Schiff, M.D., under the qui tam provisions of the False Claims Act in the United States District Court for the Middle District of Florida. DOJCatch of the Week -- Prime Healthcare
Posted 08/9/18
August 3, 2018
Prime Healthcare Services and related entities, as well as its CEO Dr. Prem Reddy, will pay $65 million to settle two Medicare fraud allegations. First, Prime and Dr. Reddy allegedly engaged in a centralized scheme to boost inpatient admissions of patients who had no medical need to be admitted. Second, they allegedly falsely upcoded patients’ diagnoses in order to increase reimbursements. Whistleblower Karin Berntsen, who initiated the lawsuit, will receive over $17 million of the settlement. DOJ; CDCAJuly 10, 2018
Liberty Ambulance agreed to pay $1.2 million to settle an FCA qui tam alleging that, from 2005 to 2016, Liberty had fraudulently upcoded life support services and unnecessarily transported patients. The case was filed by whistleblower Shawn Pelletier, who will receive $264,000 from the settlement, on top of $1.2 million he had received from prior settlements with other defendants. USAO MDFLCatch of the Week -- Health Quest Systems and Putnam Hospital Center
Posted 07/13/18
This week, DOJ announced a $14.7 million settlement with NY-based Health Quest Systems, Inc. (Health Quest), and its subsidiary hospital Putnam Health Center (Putnam) based on their submission of inflated and otherwise impermissible claims for payment to Medicare and Medicaid, making Health Quest and Putnam our Catch of the Week.
The settlement resolves allegations stemming from three separate lawsuits bought by...