Healthicity Blog

The number of settlements with the government for issues of non-compliance are on the rise. And experts estimate that most physician practices are making mistakes.

For those of you unfamiliar with coding and billing, modifier -59 is a two-digit numeric code modifier that can be appended to a CPT or HCPCS procedure code, for example, and will frequently bypass many payor edits.

1. Huntsville Nursing Home Pays the United States and the State of Texas $5 Million to Settle Claims Alleging Poor Quality of Care –

Though many CIAs read very similarly, it’s good practice to read new ones to reaffirm some of the core principles of an effective compliance program.

In May of 2017, two Southwest Missouri health care organizations agreed to pay the United States $34,000,000 to settle allegations that they violated the False Claims Act by engaging in inappropriate financial relationships with referring physicians, wrote the US Department of Justice.

1. Jacksonville Cardiovascular Practice Agrees To Pay More Than $440,000 To Resolve False Claims Act Allegations For Failing To Reimburse Government Health Care Programs -

The OIG has added some more items to their work plan for this month, October 2017. Some of these new items may interest you. Staying informed is a large part of maintaining an effective compliance program.

“Any company or individual receiving anything of value in exchange for referrals should understand that their actions may have serious legal and financial consequences.”