Healthicity Blog

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...

340B Drug Pricing Program

The 340B drug pricing program was authorized by Congress in 1992 to generate savings for certain safety-net healthcare providers by allowing them to purchase outpatient drugs at discounted prices. It is estimated that the savings to 340B providers attributable to the...

On July 13, 2017, the Department of Justice (DOJ) announced the largest healthcare fraud takedown in history.

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.

Compliance officers don’t necessarily need to know everything about medical coding and modifiers, but at a minimum, compliance officers should know that modifiers matter.

In 2009, the HITECH Act was passed as a part of the American Recovery and Reinvestment Act. It provided the authority for the government to establish the Medicare and Medicaid Electronic Health Record (HER) incentive programs to promote the adoption of EHRs.

1. Electronic Health Records Vendor To Pay The Largest Settlement In The District Of Vermont: eClinicalWorks LLC to Pay $155 Million to Resolve Civil False Claims Act Allegations –