Compliance News Roundup: $150 Million in Fraud Schemes Uncovered in Southern California

Compliance News Roundup: $150 Million in Fraud Schemes Uncovered in Southern California

Posted by Healthicity
Nov 20, 2019 10:01:58 AM

1. $178,000 Fine for Billing of “P-Stim” Devices - Richard P. Frey, D.O., and Physicians Alliance Ltd. recently resolved a False Claims Act allegation, agreeing to pay $178,398.35. The issue was regarding the improper billing of “P-Stim” devices. P-Stim is an electric acupuncture device that is affixed behind a patient’s ear using an adhesive. Medicare does not reimburse for acupuncture or for acupuncture devices, though in these allegations, Frey and Physicians Alliance Ltd. billed the devices as a surgically implanted neurostimulator.

Read more about the P-Stim Scam >>

2. 25 CA Defendants Face Federal Charges Over Alleged $150 Million Fraud Schemes - Twenty five individuals in Southern California were charged for their alleged involvement in various healthcare fraud schemes that sought over $150 million from Medicare/Medicaid, private insurers, and union health benefit plans. Fourteen of those charged in federal court in Los Angeles and Santa Ana are doctors or medical professionals. “Corruption drains dollars from private insurers and public programs such as Medicare and Medicaid,” said United States Attorney Nick Hanna. “This office will continue to hold accountable anyone–including medical professionals–who seeks to bilk our nation’s health care system.”

Read about each of the schemes, and how the individuals were busted here >>

3. Deeper Than the Headlines: Overpayments Identified by the OIG for Chronic Care Management Services - The OIG, having sensed that Chronic Care Management (CCM) payments were at a high risk for overpayments, conducted an audit to determine whether physician and outpatient payments made by CMS for CCM services complied with Federal requirements. The findings of the audit confirmed their sixth sense to be correct, as they identified a total of 20,165 claims totaling $640,452 in overpayments made by CMS.

Go Deeper Than the Headline here >>

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