Healthicity Blog

1. Owner of Two New York Medical Clinics Sentenced to 84 Months for Her Role in $55 Million Health Care Fraud Scheme - “The owner of two Brooklyn, New York, medical clinics was sentenced today to 84 months in prison for her role in a $55 million healthcare fraud scheme.

The OIG has updated their work plan in the last year more frequently than in the past and recently added nine more items in September of 2017. Anytime the OIG updates their work plan, I think it’s important to take a deep dive into the new content.

There are a lot of Copy and Paste horror stories. Physicians who accidentally copy and pasted information from one patient’s record to a different patient. Or Copy and Pasting that goes rogue and suddenly, a woman with a family history of breast cancer has a history of breast cancer herself.

1. CMS and Its Claims Processing Contractors Issued Conflicting Guidance on the Proper Use of the KX Modifier for Part B Immunosuppressive Drug Claims - “Medicare Part B paid for some immunosuppressive drugs billed with the KX modifier that were not eligible for Part B payment.

When a lot of healthcare organizations consider their risk under the False Claims Act, they often think of coding and billing errors submitted on 1500s or UBs. It’s probably the first place I’d consider looking as well for the greatest risk to a Medicare or Medicaid healthcare provider.

The field of compliance isn’t as simple as hiring honest people who will hopefully “always obey the rules.” In fact, careful hiring doesn’t constitute a compliance plan at all.

1. Under ‘Observation,’ Some Hospital Patients Face Big Bills - “In April, Nancy Niemi entered Vidant Medical Center in Greenville, N.C., with cardiac problems. She stayed four nights, at one point receiving a coronary stent.

As reimbursements shift from fee-for-service to value-based payments, the need for better risk adjustment audit tools are on the rise.