Medicare Compliance & Reimbursement
LAB FRAUD FIGHTERS CAST A WIDE NET
Golden State lab operator snared in $1.3 million fraud. When it comes to health care fraud, the long arm of the law stretches extremely far. Case in point: Leaving the United States for his native Philippines didn't help Ernesto Penaflorida evade federal fraud fighters pursing him for submitting bogus bills for blood tests. According to U.S. Attorney Debra Yang's office, Penaflorida pleaded guilty to health care fraud Nov. 3 after being extradited from the Philippines. Penaflorida admitted that he and others associated with his company, Medstat Clinical Laboratory, billed Medicare and Medi-Cal for tests that Medstat not only didn't perform, but didn't even have the capacity to conduct. The tests included RBC Protoporphyrin, a test that detects iron deficiency and lead poisoning; thin layer chromatography, a test used to detect drug metabolites; chemiluminescent assay, which helps identify chlamydia and tuberculosis; and sedimentation rate, which is used to measure inflammation and infection in rheumatism patients. The feds maintain that Medstat submitted $2.2 million in fraudulent bills, and collected about $1.3 million from Medicare. Penaflorida faces up to 10 years in prison when he's sentenced Feb. 2, 2004. Lesson Learned: Fraud fighters aren't hesitant to look far and wide when it comes to prosecuting Medicare billing abuses.
Medicare Compliance & Reimbursement
- Home Health:
HHA PAYMENT CUT SLATED FOR APRIL
Medicare bill a mixed bag for HHAs. It will take experts months to suss out [...] - Rehab:
CONGRESS PUTS A CAP IN THE THERAPY CAPS
Thanks to rehab providers' tireless lobbying efforts, they can kiss the much-maligned therapy caps goodbye [...] - Payment Errors:
ARE PAYMENT ERRORS WORSE THAN CMS SAYS?
Senate fraud hawk chides CMS with tinkering with error figures. Health care providers shouldn't jump to [...] - Disease Management:
TRIO OF HEALTH PLANS TAPPED FOR MEDICARE DM PILOT
Will disease management find a happy home in Medicare? Health plans that haven't yet jumped [...] - DME:
SUPPLIERS BID FAREWELL TO ANTI-BIDDING HOPES
No good news for DME in newly passed legislation. The new prescription drug benefit is [...] - Rehab:
REHAB PROVIDERS CHEER FEE SCHEDULE FIX
2004 physician fee schedule speaks to PT-OT-and SLP-specific issues. Congress stepped in to save rehab [...] - Psychiatric Facilities:
7 KEY ELEMENTS OF THE INPATIENT PSYCH FACILITY PPS PROPOSAL
2,000 psychiatric hospitals and units brace for a new reimbursement era. Yet another class of [...] - People:
SCULLY TO STEP DOWN
Tom Scully is leaving his post as Centers for Medicare & Medicaid Services Administrator, effective [...] - Labs:
LAB FRAUD FIGHTERS CAST A WIDE NET
Golden State lab operator snared in $1.3 million fraud. When it comes to health care [...] - Labs:
THE WRONG INSTRUCTIONS COULD LEAD TO A CLIA CITATION
What labs should watch for on tests that could be waived or moderate complexity. Labs had [...] - BILL WATCH
The following bill was introduced in the Senate before it adjourned for the holidays: S. [...] - CME MANUAL UPDATE
Providers of ambulance services can gain a bit of insight into how carriers calculate the [...]
