Healthicity Blog

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.

An organization that fails to create and maintain an effective compliance program could be forced to return overpayments. And providers may face severe civil, criminal, and financial penalties.

1. Mylan Agrees to Pay $465 Million to Resolve False Claims Act Liability for Underpaying EpiPen Rebates - “Pharmaceutical companies Mylan Inc. and Mylan Specialty L.P. have agreed to pay $465 million to resolve claims

1. Three Companies and Their Executives Pay $19.5 Million to Resolve False Claims Act Allegations Pertaining to Rehabilitation Therapy and Hospice Services

1. Los Angeles Hospital Agrees to Pay $42 Million to Settle Alleged False Claims Act Violations Arising from Improper Payments to Physicians -

1. Orlando Doctor and Infusion Clinic Owner Sentenced to 64 Months and 90 Months in Prison for Role in Medicare Fraud -

1. Genesis Healthcare agrees to pay $53.6M to settle fraud allegation - “Pennsylvania-based Genesis Healthcare Inc. has agreed to pay the federal government $53.6 million to settle six False Claims Act lawsuits that accused the company of defrauding government healthcare programs.