medicaid fraud
FL system settles federal claim over MD overpayments
Baptist Health South Florida has agreed to pay the federal government $7.75 million to settle allegations that it paid an oncology group excessive compensation to generate referrals for two of its... Read more...
Report: Antifraud compliance getting tougher for hospitals
A new report from the Deloitte Forensic Center argues that it's getting increasingly difficult for hospitals to comply with state and federal anti-fraud rules given the surge in new anti-fraud... Read more...
TN makes doctor shopping a felony
As every physician knows, there's a small but determined percentage of the population who will do whatever it takes to get their drug of choice--including seeing multiple doctors for the same... Read more...
Lawmakers question California Medicare audits
A Medicare auditing firm part-owned by the husband of a U.S. Senator has come under intense scrutiny by the California state legislature, dogged by claims that it's rejecting claims unfairly just to make profits for itself. The company, PRG-Schultz International, is contracted with CMS to examine reimbursements and identify inappropriate payouts. PRG-Schultz gets 30 percent of any overcharges it finds. The California Hospital Association has said that PRG-Schultz is on a rampage, …
... Read more...Doctor wins $6.3M in defamation case
A Dallas-area anesthesiologist won a $6.3 million judgment this week against the anesthesiology firm where he once served as a shareholder. A jury awarded Dr. Neal Fisher $6.3 million from Pinnacle Anesthesia Consultants in the defamation and breach of contract case, which arose from Fisher's firing by the practice. Fischer had claimed that Pinnacle fired him after he expressed concern that Pinnacle services were being billed out-of-network. In the suit, Fischer said that when he …
... Read more...Doctor sues CT after Medicaid fraud allegation
A Stamford, CT-based ophthalmologist has filed a federal lawsuit against the state's Department of Social Services (DSS) after being named as the first doctor the agency recommended for Medicaid fraud prosecution, claiming that he is the victim of a campaign of retribution by angry officials. Weber's suit also names the state attorney general's office, alleging, among other things, that assistant state's attorney Nancy Salerno acted "maliciously" in executing a search warrant during …
... Read more...NJ hospital plans private-to-public conversion
Hoboken, NJ-based St. Mary's Hospital isn't in great shape. It lost almost $100 million over the last five years and seldom fills more than half of its 328 beds. Worse, as the oldest hospital in the state, it needs millions of dollars worth of upgrades and renovations. But when the hospital's owner, Bon Secours Health Care System, said it would close St. Mary's, state legislators worked out a plan to keep it afloat by funneling in state funds and turning over operations to the city. The …
... Read more...NY gets $1.5B to close ailing hospitals
If the threat of closing a single community hospital mobilizes neighborhoods, polarizes physicians and puts local politicians on the hot seat, imagine what the next five years will look like for New York state officials. In a long-negotiated deal, the state of New York has accepted $1.5 billion from the federal government to assist New York in shoring up its ailing hospital …
... Read more...ALSO NOTED: Colorado posts death rates; Sierra, HCA wrangle over contract; and much more...
> Sierra Health Services, Nevada's largest insurer, is nearing the end of its contract with three HCA hospitals in Las Vegas. Both sides hope they can renegotiate a contract before time runs out. Article
> In Florida, HCA has started a program to ease ER overcrowding. HCA hospitals will refer non-emergency patients to nearby clinics. Critics say the program will only serve to …
... Read more...SPOTLIGHT: Watch out for whistleblowers
A provision in the Deficit Reduction Act of 2005 makes it easier than ever for hospital employees to call in regulators if they suspect Medicaid fraud. "The provisions contain incentives that encourage states to enact Medicaid anti-fraud legislation modeled after the federal False Claims Act," Philip Betbeze of HealthLeaders magazine notes. This, he observes, could cause some serious headaches for hospital administrators. Article
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