Healthicity Blog

1. Medicaid Fraud Control Units: Investigation and Prosecution of Fraud and Beneficiary Abuse in Medicaid Personal Care Services –

The OIG posted their most recent advisory opinion (AO) on Dec. 11th, 2017. Let’s talk about it.

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.

1. Meadows Regional Medical Center, Inc. and Affiliates To Pay Up To $12.875 Million To Resolve Alleged False Claims Act Violations -

For many years now the OIG has been performing Medicare Compliance reviews of hospitals.

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.

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.