Compliance News Roundup: Another $26 Million Found in Healthcare Fraud Busts

Compliance News Roundup: Another $26 Million Found in Healthcare Fraud Busts

Posted by Healthicity
Nov 13, 2019 11:15:24 AM

1. NJ Doctor Pleads Guilty to $13 Million Telemedicine Fraud Conspiracy - Joseph DeCorso, 62, a New Jersey physician, pleaded guilty for his role in a $13 million fraud scheme. DeCorso admitted that he worked for two purported telemedicine companies and wrote medically unnecessary orders for orthotic braces. DeCorso agreed to pay over $7 million in restitution to the United States, and forfeit assets and property that were traced to he generated as part of the conspiracy.

Read more about the plea deal here >>

2. Hospital Administrator Gets 10 Years in Prison for $16 Million Healthcare Fraud - According to evidence presented at trial, Starsky Bomer, 46, a hospital administrator of Atrium Medical Center and Pristine Healthcare, and his co-conspirators engaged in a scheme to defraud Medicare by submitting approximately $16 million in false and fraudulent claims for partial hospitalization program services. Bomer was convicted of one count of conspiracy to receive health care kickbacks, two counts of violating the Anti-Kickback Statute, and one count of conspiracy to commit healthcare fraud.

Read more about their scheming ways here >>

3. Deeper Than the Headlines: Post-Acute-Care Transfers Led to Millions in Inappropriate Payments - The OIG recently audited how hospitals have been reimbursed patient discharge status codes. Of the 18,647 claims they reviewed, it was determined that Medicare improperly paid $54.4 million. The review based on a previous audit that identified almost $242 million in overpayments to hospitals that did not comply with Medicare’s post-acute-care transfer policy.  As a result, the OIG had some recommendations to CMS (which were agreed to), that will result in recovery of improperly paid funds and future plans to stop the bleeding.

Go deeper than the headlines >>

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