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Justice Department: Medical firm to pay $14.5 billion to settle fraud allegations

  Tacoma, Wash.-based physician provider, Sound Inpatient Physicians Inc. has agreed to pay $14.5 million to settle recent allegations that it manipulated medical claims and records to swindle millions from Medicare. Sound Inpatient Physicians Inc. will pay $14.5 million to settle allegations that it overbilled Medicare and other federal health care programs, the Justice Department announced today.  Sound Physicians is a Tacoma, Wash.-based provider of hospitalists and other physicians to hospitals and other medical facilities.  It employs more than 700 hospitalists and […]

Star Tribune: Justice Department, 55 hospitals reach $34 million settlement over Medicare fraud claims

  For the second year in a row, the Department of Justice has settled a multi-million-dollar dispute with hospitals over unnecessary use of expensive spinal procedures. States involved in the settlement include: Alabama, California, Delaware, Florida, Georgia, Hawaii, Iowa, Kansas, Kentucky, Louisiana, Massachusetts, Michigan, Mississippi, Montana, Nevada, North Carolina, North Dakota, Ohio, Oklahoma, Tennessee, and Texas. FROM THE STAR TRIBUNE:  Fifty-five hospitals in 21 states have agreed to pay $34 million to the U.S. government to settle allegations that they […]

Coalition Highlights Low Cost, High Effectiveness of Recovery Audit Contractor Program Amid Federal Budget Cuts

  FOR IMMEDIATE RELEASE July 2, 2013 Coalition Highlights Low Cost, High Effectiveness of Recovery Audit Contractor Program Amid Federal Budget Cuts RACs fill gaps in fraud prevention, yield billions in return on investment Washington, D.C. – The American Coalition for Healthcare Claims Integrity (ACHCI) today issued a statement following the announcement by the Department of Health and Human Services Office of Inspector General (OIG) that significant staff and budget reductions are on the horizon. The department conceded the cuts […]

U.S. Department of Justice: Four Convicted in Medicare Fraud Scheme

  Four individuals from the Miami, FL metro area have been convicted of filing almost $70 million in fraudulent Medicare claims. WASHINGTON – A federal jury today convicted four individuals for their participation in a Medicare fraud scheme involving nearly $70 million in fraudulent billings by Hollywood Pavilion (HP), a mental health care hospital. Today’s verdict was announced by Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District […]

Coalition Applauds Senate Finance Committee’s Effort to Improve and Strengthen Recovery Audit Contractor Program

FOR IMMEDIATE RELEASE June 26, 2013 Coalition Applauds Senate Finance Committee’s Effort to Improve and Strengthen Recovery Audit Contractor Program Committee hearing highlights importance of communication and collaboration between providers and auditors Washington, D.C. – The American Coalition for Healthcare Claims Integrity (ACHCI) today issued the following statement regarding the U.S. Senate Committee on Finance hearing, Program Integrity: Oversight of Recovery Audit Contractors, chaired by Senators Max Baucus (D-MT) and Orrin Hatch (R-UT). “We commend members of the Senate Finance […]

Statesman: Austin doctor accused of $2.1 million Medicare fraud

  Two Austin medical practitioners have been accused of defrauding $2.1 million in Medicare funds. FROM STATESMAN.COM Dr. Dennis B. Barson Jr., an Austin neurologist, and his medical clinic administrator, Dario Juarez, were charged in a multicount indictment with conspiracy to defraud Medicare of $2.1 million over a two-month period, U.S. Attorney Kenneth Magidson said Tuesday. The indictment also accuses Barson, 40, of Austin, and Juarez, 53, of Beeville, with health care fraud for filing false Medicare claims for procedures that were […]

Fierce Healthcare: OIG: Medicare overpays $2.8M to two hospitals and Wisconsin

  The Office of Inspector General has released three reports showing two hospitals and the State of Wisconsin collectively over-billed Medicare by $2.8 million. FROM FIERCE HEALTHCARE: In the first report, the OIG says Community Regional Medical Center in Fresno, Calif., received $1.1 million in overpayments for 230 inpatient and outpatient claims with dates of service from 2008 to 2012. Investigators conclude the overpayments occurred because the hospital did not have adequate controls to prevent the incorrect billing of Medicare claims within […]

Politico Pulse: Bipartisan Foursome Offers Medicare Fraud Prevention Measure

  This week, members of Congress reached across the aisle to jointly propose a new piece of sweeping, anti-healthcare-fraud legislation. FROM POLITICO PULSE: Two Democrats and two Republicans introduced legislation Tuesday they say will curb waste and fraud in Medicare and Medicaid. The “Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2013,” or PRIME Act, tackles a slew of thorny oversight issues, toughens penalties for fraudsters, attempts to phase out so-called “pay and chase” practices used by anti-fraud […]

Coalition Member Weighs in on PRIME Act

  HMS, a Proper Payments coalition member, sent the following letter to Reps. John Carney (D-Del.) and Peter Roskam (R-Ill.) in support of the Preventing Improper Medicare & Medicaid Expenditures (PRIME) Act. FROM HMS: Dear Representatives Carney and Roskam: As a leader in cost containment and program integrity services for government healthcare programs, HMS is honored to support the Preventing Improper Medicare & Medicaid Expenditures (PRIME) Act, which aims to curb waste, fraud, and abuse in Medicare and Medicaid programs. […]

Coalition Applauds Bipartisan Effort to Combat Billions of Dollars in Healthcare Waste, Fraud and Abuse

FOR IMMEDIATE RELEASE June 12, 2013 Coalition Applauds Bipartisan Effort to Combat Billions of Dollars in Healthcare Waste, Fraud and Abuse PRIME Act will help curb improper payments, strengthen Medicaid and Medicare Washington, D.C. – The American Coalition for Healthcare Claims Integrity (ACHCI) today issued the following statement regarding the Preventing Improper Medicare & Medicaid Expenditures (PRIME) Act, a bill proposed by Senators Tom Carper (D-Del.) and Tom Coburn (R. Okla.), as well as Reps. Peter Roskam (R-Ill.) and John […]