Doctor Indicted of Insurance Billing and Medicare Fraud For Falsifying Diagnosis

May 07, 2012
A federal grand jury in Birmingham, AL indicted a physician for fraud totaling about $1.3 million for billing Blue Cross Blue Shield and Medicare for non-reimbursable cosmetic skin treatments. The 96-count indictment filed in U.S. District Court charges DIANA K. McCUTCHEON, 54, with committing health care fraud and wire fraud through her 2 medical clinics in Alabama.

Apex Medical Group Pays $4.36 Million For Federal & State Health Care Fraud

May 07, 2012
A government investigation revealed that from at least 2001 through 2006 Apex Medical Group in Knoxville, TN submitted numerous false and fraudulent claims to government health programs, including Medicare and TennCare, for payment through a pattern of upcoding for various physician services.

MGMA Launches RAC WATCH - Increased RAC Audit Activity

May 07, 2012
Medicare Recovery Audit Contractors (RACs) are tasked with identifying and recouping overpayments and refunding underpayments. In fiscal year 2011, RACs identified $939.3 million in improper payments, and this year they are on track to nearly double that number based on activity in the first quarter. To help gather information — and provide you with valuable resources — The MGMA created a way for you to share your perspectives through RAC WATCH, a new outreach initiative outlined below.

Meet the Top 10 Compliance Challenges - Part 2

Mar 26, 2012
This month, we conclude this two-part series with a look at the top five compliance risks, and some tips to ensure you meet these challenges effectively.

Houston Internist Gets 70 Months + $3.8m FINE for Unbundling and Billing for Services Not Done

Nov 22, 2011
An certified internist in Houston was nailed for mail fraud for "unbundling" his bills to insurance companies.

Office Manager and Doctor Sentenced for Defrauding Medicaid & Medicare of $3 Million

Nov 22, 2011
The Office Manager plead guilty to fraud charges of knowingly billing for services that were not provided and was sentenced to a fine of $50,000 and 200 hours of community service.

OIG Work Plan Issues for Pain and Anesthesia Providers

Oct 26, 2011
We hope that by providing you with sections of the OIG work plan (originally from the Auditing for Compliance and Education (ACE Newsletter), it will help you formulate your audit plan for 2012

Medicare RAC Audit on MRIs

Sep 26, 2011
CRS has been working on our behalf to resolve the erroneous demands letters for repayment from the RAC Auditor Health Data Insights for MRI procedures alleging the patient had a pacemaker at the time of the MRI. Below is a memo from the CRS that will go out to its membership summarizing the issue and it's resolution.

CMS finalizes Medicaid RAC rule

Sep 22, 2011
States must have Medicaid recovery audit contractor (RAC) programs in place to identify improper payments beginning Jan. 1, 2012, according to a final rule released by the Centers for Medicare & Medicaid Services (CMS).

The RAC Audit Counterattack

Sep 12, 2011
Prediction - your practice will be audited in the next 24 months and asked to return overpayments. The writing is on the wall.