News From Around the Web
> A Dyer County (Tenn.) grand jury indicted six people involved in doctor shopping and the resale of prescription drugs paid for with TennCare benefits, according to the state's Department of Finance & Administration. The Office of Inspector General and the Dyersburg Police Department provided evidence those arrested used TennCare benefits to obtain painkillers anti-anxiety medication through multiple providers. Statement
> Staten Island oncologist Gil Lederman, best known for treating Beatles guitarist George Harrison, agreed to pay $2.5 million for miscoding claims between 1996 and 2003, according to the New York Post. Lederman became infamous for asking Harrison to sign a guitar on his deathbed. Article
> Unsealed search warrants shed light on a Florida fraud investigation involving medical clinics partially owned by St. Johns County Commissioner Bill McClure. The search warrants indicate that McClure and his mother, Paula Stowell, falsely billed Medicaid and Medicare and forged prescriptions documents, according to The Florida Times-Union. In interviews with investigators, former employees described being told to change billing codes to higher reimbursement services. Article
Healthcare Payer News
> The news magazine 60 Minutes said on a recent show that insurers are denying mental health claims for patients in need of chronic long-term mental healthcare. In fact, the show said Anthem had more than a 90 percent denial rate for mental health claims. Article
Healthcare Finance News
> Hospitals still continue to aggressively appealing claims denials by Recovery Audit Contractors and get a large percentage of them overturned, according to new data from the American Hospital Association's RACTrac Survey. RACs also are becoming more aggressive in terms of denying outpatient claims for payment. Article
And finally ... Further proof that dogs and cats are friends. Video