Medicare Compliance & Reimbursement
Feds Crack Down On Vaccine Billing Errors
Investigation turns costly for two CT pediatric practices.
Practices that regularly submit claims to Medicaid under the Vaccines For Children (VFC) program need to make sure that they are billing only the related administrative costs - and not the vaccines.
Two pediatric practices agreed to separate civil settlements Jan. 3, U.S. Attorney Kevin O'Connor said. Torrington-Winsted Pediatric Associates and Pediatric & Adolescent Healthcare (PAH), and its former owner Dr. William Silberberg, agreed to pay a total of $850,000 to resolve allegations that they were overpaid for inoculations.
Between January 1997 and May 2004, prosecutors say that both practices billed Medicaid and other insurance plans for vaccine doses that the practices received for free from the VFC program. The provider should recover only a minimal fee for the administration, O'Connor said.
Torrington-Winsted Pediatric Associates will pay the government more than $200,000 - double the damages incurred. The practice has also agreed to reimburse private payers approximately $300,000. PAH and Dr. Silberberg will pay over $350,000.
Each facility has entered into Integrity Agreements with the U.S. Department of Health and Human Services. Neither has admitted liability.
"Providers know or should know they cannot bill for something they get for free," said O'Connor. "We will make every effort to recover VFC funds and impose multiple damages and penalties where appropriate."
Lesson Learned: Vaccine billing compliance issues continue to sound alarm bells for investigators.
Medicare Compliance & Reimbursement
- Physicians:
Docs Kissed Nearly $1 Billion Goodbye In 2004
But the AMA doesn't want to tinker with E/M coding again
Physicians are losing thousands of [...] - Physicians:
Docs Could Be Selling Themselves Short
14.4 percent of claims could have supported higher-paying codes.
For 14.4 percent of claims processed by [...] - Legislation:
Reductions Could Hit Medicare & Medicaid, Staffers Warn
Times are tight for the federal government, and that will affect providers of all stripes.
If [...] - Rehab:
Sharpened Medical Necessity Focus Could Cripple IRFs
Newly enforced requirement comes as a surprise to many.
Medicare's fiscal intermediaries have received their marching [...] - Coverage:
Medicare Pumps Up Insulin Coverage
Older patients can now benefit from stem cell transplants.
The Centers for Medicare & Medicaid Services [...] - Drug Coverage:
Plans And PBMs Cheer, Big Pharma Jeers Guidelines
CMS chooses a compromise for the new Part D formulary.
On Jan. 3, the United States [...] - Enforcement Watch:
Feds Crack Down On Vaccine Billing Errors
Investigation turns costly for two CT pediatric practices.
Practices that regularly submit claims to Medicaid under [...] - Medicaid:
Governors Wary Of Too Much Change On Medicaid
But the federal government is searching for ways to cut budgets.
President Bush's choice of former [...] - Bill Watch
The following bills were introduced in the House: HR 5393. A bill to amend title [...]
