Healthicity Blog

1. McDonough woman pleads guilty to Medicaid fraud, ordered to pay $3.8 million – “The owner of a former Henry County mental health services business will have to pay $3.8 million in restitution to the Georgia Medicaid Program for alleged Medicaid fraud.

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

Those of you who have been following my work on the Healthicity blog, my webinars and/or speaking engagements know that one of my topics of choice is the government's increased efforts to hold individuals, not just organizations, accountable for suspected non-compliance.

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.

Recently, compliance failures cost Florida physicians over $4 million dollars and resulted in a multi-million dollar settlement for a Tennessee hospital. The message is clear: compliance is no joke.

1. Fort Worth Brothers Admit Role in $36 Million Lab Test Kickback Scheme - Two Fort Worth men pleaded guilty Friday afternoon to playing a role in an alleged $36 million fraud scheme involving unnecessary lab tests of saliva and urine that were billed to the U.S. military’s health care system.

You want to improve your compliance program but just don’t have the time for a total overhaul at the moment. Well, have no fear, because there are a few small tweaks you can make that can have a huge impact on your program. And the good news is that it’s easier than you think.