Compliance News Roundup: A CEO Calls it Quits For Fear of Legal Action

Compliance News Roundup: A CEO Calls it Quits For Fear of Legal Action

Posted by Healthicity
Feb 15, 2017 11:28:18 AM

1. OIG report: Vidant Medical Center Incorrectly Billed Medicare Inpatient Claims with Severe Malnutrition (A-03-15-00011) - Vidant Medical Center (the Hospital), in Greenville, North Carolina, complied with Medicare billing requirements for diagnosis codes 261 and 262 for 11 of the 100 claims that we reviewed. However, the Hospital did not comply with Medicare billing requirements for the remaining 89 claims. For two of these claims, the medical record documentation supported a secondary diagnosis code other than 261 or 262, but the error resulted in no change to the diagnosis-related group or payment. For the remaining 87 claims, the billing errors resulted in net overpayments of $402,000. These errors occurred because the Hospital used diagnosis code 261 or 262 when it should have used codes for other forms of malnutrition or no malnutrition diagnosis code at all. On the basis of our sample results, we estimated that the Hospital received overpayments of at least $1.4 million over 2 1/2 years. Read more here: http://go.usa.gov/x962B.

2. Kentucky pain doctor to pay $20 million over allegations of false billing - A doctor who had pain-management clinics in several Kentucky cities has agreed to pay $20 million to settle allegations of submitting false bills to insurance programs. The U.S. Department of Justice announced the settlement against Robert E. Windsor Wednesday. Windsor, who lives in Georgia, owned pain-management clinics there and in Kentucky that operated under the umbrella of National Pain Care, Inc., according to a news release from the Department of Justice. Read more here: http://www.kentucky.com/news/local/counties/fayette-county/article130168269.html

3. Deeper Than The Headlines: A CEO Calls it Quits For Fear of Legal Action - Most of us by now have heard of the Yates’ Memo. It directs the Department of Justice attorneys to hold individuals accountable for inappropriate actions associated with corporate wrongdoing. There’s been an apparent increase in the headlines, which demonstrates that the government is trying to hold more individuals accountable. When Ms. Yates announced the memo in 2015 she also gave a speech in which she admitted this focus might result in some government losses while trying to hold individuals accountable. Read more here: http://www.healthicity.com/blog/ceo-calls-quits-for-fear-of-legal-action

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