Compliance News Roundup: Graduate Medical Education (GME) Payments

1. $5.1 Million Dollar Settlement Reached With Indiana Dental Firm To Resolve False Claims Allegations – “United States Attorney Russell M. Coleman announced today that ImmediaDent of Indiana, LLC (ImmediaDent), which operates nine dental care practices in Indiana, and Kansas based Samson Dental Partners, LLC (SDP), which provides administrative support services to ImmediaDent, have agreed to pay the United States and the State of Indiana $5.139 million to resolve allegations that they improperly billed Indiana’s Medicaid program for dental services; the companies have been determined to continue to be a high risk to the United States health care programs and their beneficiaries.” Get the full scoop >>

2. Manhattan U.S. Attorney Announces $2 Million Settlement Of Health Care Fraud Claims Against Metropolitan Retina Associates, Inc., And Dr. Kenneth Felder – “Geoffrey S. Berman, the United States Attorney for the Southern District of New York, and Scott J. Lampert, Special Agent in Charge for the New York Office of Inspector General of the U.S. Department of Health and Human Services (“HHS-OIG”), announced today a settlement of a civil fraud lawsuit against DR. KENNETH S. FELDER (“FELDER”) and METROPOLITAN RETINA ASSOCIATES, INC. (“METROPOLITAN RETINA”). The settlement resolves claims under the False Claims Act alleging that FELDER and METROPOLITAN RETINA billed Medicare and Medicaid for (1) substandard fluorescein angiography tests that were of such poor quality that they lacked all diagnostic value and were effectively worthless; and (2) ophthalmic ultrasounds that were either not performed or lacked any supporting documentation. Under the terms of the settlement approved by U.S. District Judge Alison J. Nathan, FELDER and METROPOLITAN RETINA admitted and accepted responsibility for their conduct and agreed to pay $2,064,559 to the United States.” Get the full scoop >>

3. Deeper Than the Headlines: Graduate Medical Education (GME) Payments – One of the OIG’s most recent published audit reports explains their review of Graduate Medical Education (GME) payments. The OIG’s purpose in performing this review was to determine whether CMS ensured that hospitals in selected MAC jurisdictions claimed Medicare GME reimbursement in accordance with Federal requirements. According to the OIG, they have previously found that hospitals in six Medicare Administrative Contractor (MAC) jurisdictions counted residents (including interns) as more than one full-time equivalent (FTE) and, as a result, received excess Medicare graduate medical education (GME) reimbursement. Get the full scoop >>

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