Healthicity Blog

1. Medicare Fails To Recover Hundreds Of Millions Of Dollars In Lab Overcharges - “Five years ago, Companion DX Reference Lab hoped to cash in on cutting-edge genetic tests paid for by Medicare.

1. Dallas-Based Physician - Owned Hospital to Pay $7.5 Million to Settle Allegations of Paying Kickbacks to Physicians in Exchange for Surgical Referrals -

On November 30th, the OIG posted its Semiannual Report to Congress. The report is a summary of the OIG’s activities from April 1, 2017 to September 30, 2017.

The appropriate use of Modifier 25 can be a little tricky because the requirements are ultra-specific. On the one hand, Modifier 25 is really handy.

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.

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.

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.

1. Pitt County Behavioral Health President Pleads Guilty to Medicaid Fraud Conspiracy and Perjury Charges - “The United States Attorney for the Eastern District of North Carolina John Stuart Bruce Office announced that yesterday in federal court, Shephard Lee Spruill, II, 46, of Winterville, North...