Medicare Compliance & Reimbursement
PHYSICIAN FACES 'SHOCK' PROBATION
Upcoding leads to weekends behind bars Health care fraud enforcers are using the latest trends in criminal sentencing to lay down the law on compliance violations. According to New York Attorney General Eliot Spitzer, Bath, NY physician Dr. Ashar Tahir, after pleading guilty to fraud charges July 23, agreed to a sentence of six months' "shock probation," community service and five years probation. Shock probation means Dr. Tahir will be incarcerated during the weekends, and spend weekdays under electronic home monitoring. According to prosecutors, Tahir submitted bogus reimbursement claims to Medicare, Medicaid and another payer in which he overstated the extent of the services he provided. As part of the plea agreement, Tahir will make more than $650,000 in restitution. If Tahir violates the terms of the agreement, he could face up to seven years in prison. Lesson Learned: Exaggerating the level of services you provide could land you behind bars - so make sure your compliance program will stop inappropriate claims before they leave your office.
Medicare Compliance & Reimbursement
- Long-Term Care:
BETTER PAY FOR HIGH-QUALITY CARE?
SNFs must prepare for a proposed link between payment and QI data. If a skilled [...] - HIPAA:
HIPAA, UNPREPARED PROVIDERS COULD CAUSE CLAIMS NIGHTMARES
Some provider groups are predicting a claims "train wreck." Three months before the Health Insurance [...] - Long-TermCare:
WHAT THE 2004 ADJUSTMENTS MEAN FOR NURSING HOMES
Industry braces for much-needed cash infusion. Skilled nursing facilities are in for a significant payment [...] - Medicare Reform:
DISCOUNT CARD AGREEMENT PUTS MOMENTUM BACK IN MEDICARE REFORM NEGOTIATIONS... BUT FOR HOW LONG?
House and Senate Medicare conferees have reached a "tentative agreement" on rules for prescription-drug discount [...] - HealthPlans:
WHY HEALTH PLANS HATE THE IDEA OF MEDICARE 'REGIONS'
The White House, House, and Senate all want to ensure health-plan choices for Medicare beneficiaries [...] - DME:
WHEN IS IT OK TO GIVE A FREE UPGRADE?
It's more often than you might think. Some suppliers might be scared off from furnishing [...] - Rehab:
WHAT'S MISSING FROM THE 2004 IRF PAYMENT UPDATE
Controversial 75 percent rule still unsettled. Inpatient rehabilitation facilities will get a 3.2-percent raise in [...] - Hospitals:
CMS PROPOSES 3.8-PERCENT OPPS UPDATE
Hospital payments under the outpatient prospective payment system would get a 3.8-percent increase under the [...] - Pharmaceuticals:
LOOKING INWARD ON MEDICAID PRICING, REBATES
Sparked by federal scrutiny, drugmakers examine compliance practices. Medicaid rebates and drug pricing issues are [...] - Rehab:
HOW RELATED PARTY ISSUES CAN LAND PROVIDERS IN PRISON
When a compensation package is too good to be true. A Missouri rehab operator capped [...] - Physicians:
PHYSICIAN FACES 'SHOCK' PROBATION
Upcoding leads to weekends behind bars Health care fraud enforcers are using the latest trends [...] - HomeCare:
LAWMAKERS COULD TARGET HOME CARE FOR CUTS
It just may have become more difficult to get negative home care provisions out of [...] - Medicare+Choice:
2 FLORIDA M+COS BUSTED FOR MARKETING VIOLATIONS
As the competition to enroll Florida seniors in Medicare+Choice plans heats up, more health plans [...] - PROGRAM MEMO ROUNDUP
Starting Jan. 1, 2004, patients will have a better sense of what's going on if [...]
