Healthicity Blog

Most healthcare fraud and abuse cases settle before ever going to trial. However, when they occasionally do go to trial, the outcomes can be as varied as the facts and circumstances of a specific case. A recent trial in Houston didn’t turn out so well for Dr. Ronald Kahn, a Houston physician.

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.

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.

We all “report up” to somebody at some point and that goes for the OIG, too, in their regular reports to Congress. Recently, the OIG submitted its Semiannual Report to Congress for the period of Oct. 1, 2016 to March 31, 2017.

1. Retina surgeon’s AMD regimen at center of Medicare fraud case: Earlier this month, a jury convicted West Palm Beach retina surgeon Solomon Melgen, MD, on 67 counts of Medicare fraud.

Healthcare fraud and abuse are hot topics right now, it’s more important than ever to get on top of new codes and keep your practice audit-ready. Knowledge is power. This handy list will help you update CPT codes and stay current. Educate providers and staff using the following auditing resources.

“…let me be clear: healthcare fraud is a priority for the Department of Justice,” is how Kenneth Blanco, acting Assistant Attorney General of the DOJ’s Criminal Division, began his speech on May 18, 2017, at the Institute on Health Care Fraud of the American Bar Association.