Medicare Compliance & Reimbursement
Miami Providers Beware--The Feds Have Their Eyes On You
Miami appears to be ground zero for health care fraud prosecutions right now. A jury found physician Frantz Achille guilty of conspiracy and health care fraud. Achille was a physician at two Miami HIV/AIDS clinics and allegedly forged medical paperwork to receive $2.1 million from Medicare. Patients either never needed the expensive treatments or never received them. The clinic paid patients a kickback to show up, prosecutors said.
Meanwhile, Miami physician Julian Torres was arrested Jan. 30 and charged with conspiracy and other federal crimes. The owners of Carob Medical Services allegedly paid $20,000 in kickbacks to Torres to prescribe medical equipment for patients who didn't need it. Carob received around $1 million from Medicare for this equipment.
Finally, Diana Sotto, owner of All Medical Billing Systems, was sentenced to 10 years' imprisonment, followed by three years' supervised release. She helped Miami clinic Project New Hope to defraud Medicare of more than $2.8 million from Sept. 2004 to Sept. 2005, billing for HIV/AIDS medications for patients who actually were HIV-positive but didn't receive the medication.
Medicare Compliance & Reimbursement
- PHYSICIANS:
Warning--Use 77 Modifier And Make Sure Your Diagnosis Codes Are Different
Crackdown may hit your subspecialty consults extra hard.
Heads up: You may be seeing a wave [...] - BILLING:
Why You Should Benchmark Your Denials
Check by payor, site procedure code and other factors.
Are you keeping track of your denials? [...] - TRANSMITTALS:
Start Billing For Diabetes Self-Management Training
Bonus: Use this code for lumbar artificial disk replacement.
Medicare will cover 10 hours of initial [...] - CARDIOLOGY:
Medicare Dashes Coumadin Clinics' Hope For Reimbursement
Stick with 85610 and 99211 for Coumadin management.
Providers were excited when CPT 2007 introduced two [...] - HEALTH IT:
EHRs Might Hold The Key to Cancer, Diabetes And Other Diseases
New databases make it possible to hold virtual clinical studies.
The Department of Health and Human [...] - SPECIAL REPORT:
New Plan To Reduce Health Care Costs Focuses On Increases In Health Care Outlays
Is $1.4 trillion in savings too little too late?
The United States currently spends more than [...] - FRAUD & ABUSE:
Miami Providers Beware--The Feds Have Their Eyes On You
Investigators find millions of dollars worth of improper Medicare payments.
Miami appears to be ground zero [...] - INDUSTRY NOTES:
Fed Chairman Urges Steep Medicare Cuts
Plus: Quality guidelines paid off for chronic patients.
The right time to start slashing Medicare spending [...]
