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FierceHealthcare: OIG hospital audits reveal $2.26M in Medicare overpayments

  According to a report released by the Office of Inspector General last week, negligent billing practices led to a Massachusetts hospital system pocketing over $1 million in Medicare overpayments. The New England hospital, along with two other hospitals reviewed by the OIG, contributed to $2.26 million in improper payments overall. FROM FIERCEHEALTHCARE: Southcoast Hospitals Group received $1,106,581 in Medicare overpayments in 2010 and 2011 because the three-hospital system in Massachusetts lacked adequate controls to prevent incorrect billings, according to an […]

The Tennessean: Vanderbilt Medical Center hit with Medicare fraud suit

  A new lawsuit claims Vanderbilt University Medical Center engaged in Medicare fraud for over 10 years, and that the hospital used a sophisticated software program to perpetuate the billing scheme. FROM THE TENNESSEAN: According to the lawsuit, Vanderbilt double-booked attending physicians, making it impossible to meet Medicare billing standards, but VUMC billed state and federal insurers as if it had complied with regulations. “As Vanderbilt is aware, many surgeons’ routine practice is to simultaneously schedule multiple surgeries in multiple […]

OIG: Hospitals Account for 88 Percent of Improper Payments

  FOR IMMEDIATE RELEASE September 9, 2013 OIG: Hospitals Account for 88 Percent of Improper Payments HHS Report highlights effectiveness of Recovery Auditors, reveals hospitals as top contributors to Medicare waste, fraud and abuse Washington, D.C. – The American Coalition for Healthcare Claims Integrity today responded to a new Department of Health and Human Services Office of Inspector General (OIG) assessment of the Recovery Audit Program and improper payments in Medicare. The report concluded that Medicare Recovery Auditors (RAs) are […]

New GAO Report Points to Ongoing Need for Recovery Auditing

  FOR IMMEDIATE RELEASE September 3, 2013 New GAO Report Points to Ongoing Need for Recovery Auditing In effort to combat billions in Medicare waste, recovery auditors examine more claims, recover more improper payments and are less burdensome to providers than other contractors Washington, D.C. – The American Coalition for Healthcare Claims Integrity today reacted to a new Government Accountability Office (GAO) comparison of contractors that conduct post-payment reviews of Medicare fee-for-service claims.  Recovery Auditors (RAs), who act in partnership […]

Reuters: Can an expanded army of seniors stem Medicare fraud?

  Seniors across the country are getting involved in the Senior Medicare Patrol program to take action against Medicare fraud. By providing resources such as fraud-report hotlines and information, the SMP is empowering seniors to recognize and avoid becoming victims of fraud. FROM REUTERS: The government estimates that it loses some $60 billion a year to Medicare fraud and waste, and as it gears up to launch its giant healthcare reform program to provide affordable coverage for every American, putting a […]

Orlando Sentinel: Shands Hospital pays $26 million in fraud settlement case

  A Florida-based hospital system has agreed to pay $26 million to settle a lawsuit claiming it unnecessarily admitted patients to its hospitals, and subsequently over-billed Medicare and Medicaid. FROM THE ORLANDO SENTINEL: “We uncovered a severe lack of management oversight and a systemic failure to follow Medicare and Medicaid regulations,” said whistle-blower Terry Myers in a statement. He was hired by Shands as an independent consultant in 2006 and 2007 to audit the health system’s billing practices. While making […]

Detroit Free Press: Oakland County cancer doctor accused of unnecessary treatments, defrauding Medicare of millions

  The owner of Michigan Hematology Oncology Centers has been accused of intentionally misdiagnosing patients with cancer for the purpose of prescribing unnecessary  treatments, costing Medicare more than $25 million dollars in two years. FROM THE DETROIT FREE PRESS: Patients who didn’t have cancer were diagnosed as such. Sick patients were given too-high doses of powerful drugs. Some in remission were sent for unneeded chemotherapy. End-of-life patients were pumped full of drugs that couldn’t help them anymore. These millions of […]

The New York Times: Revealing a Health Care Secret: The Price

  An Oklahoma-based ambulatory care center lists its surgical procedure prices online. Patients pay a one-time, all-inclusive fee – often at a fraction of the price of identical procedures at comparable hospitals. Could this trend of increasing transparency be key to driving down healthcare costs and mitigating fraud? From The New York Times: The Surgery Center of Oklahoma is an ambulatory surgical center in Oklahoma City owned by its roughly 40 surgeons and anesthesiologists. What makes it different from every […]

The Oakland Press: Michigan health agency owner pleads guilty in Medicare fraud scheme

  A California home health agency owner faces 10 years in prison after pleading guilty to accusations of his involvement in a $22 million healthcare fraud scheme. FROM THE OAKLAND PRESS:  West Bloomfield physical therapist assistant – who was also an owner of a home health agency and a patient recruiter — pleaded guilty Wednesday for his role in a $22 million home healthcare fraud scheme. Syed Shah, 51, pleaded guilty Wednesday before U.S. District Judge Bernard A. Friedman in […]

Miami Herald: Miami doctor and therapists charged with $63 million Medicare-fraud scam.

  Miami-area prosecutors have filed charges against one psychiatrist and six therapists for their involvement in a fraud scheme aiming to steal $63 million from Medicare. The licensed medical professionals preyed largely on patients with Alzheimer’s or dementia, and fabricated or altered their medical records to obtain higher reimbursements. From the Miami Herald: Roger Rousseau, 71, the former medical director for a defunct mental-health clinic operation, was indicted on charges of conspiring to commit health care fraud. […] According to […]