Are You Defrauding Medicare By Either Upcoding Or Downcoding Submitted Claims?
Posted by donna@healthlawcenterplc.com in Aug, 2018
Both upcoding and downcoding are significant because these actions have been interpreted as a basis for abusing and defrauding the federal government and its programs. According to CMS, “abuse describes practices that, either directly or indirectly, result in unnecessary costs to the Medicare Program.” Abusive coding practices include: Upcoding – a code with a […]
Could A Sweetheart Contract Or Lease Turn Sour?
Posted by donna@healthlawcenterplc.com in Aug, 2018
Last week the United States Department of Justice announced a settlement agreement with William Beaumont Hospital, located in the Detroit area, based on allegations Beaumont made false claims to the Medicare, Medicaid, and TRICARE programs. The allegations are based on improper relationships with eight referring physicians. Under the settlement agreement, Beaumont is required to pay […]
Post Tagged with Donna Craig, False Claims Act, Fraud & Abuse, Medicare, Physician, Stark Law, The Health Law Center Texas Supreme Court Finds Xerox, Not Dentists, Responsible For Fraudulent Medicaid Dental Payments
Posted by donna@healthlawcenterplc.com in Jul, 2018
The Texas Supreme Court recently upheld a Texas Court of Appeals ruling that Xerox was responsible for the $1 billion in fraudulent Medicaid dental payments. The state found that Texas Medicaid and Healthcare Partnership, a subsidiary of Xerox, allowed workers with limited expertise to approve dental claims for the state’s Medicaid program. Xerox, which was […]
Category: Anti-Kickback Statute, Medicaid, News & Updates
Physician And Two Nurses Found Guilty of $13 Million Home Care Fraud Scam
Posted by donna@healthlawcenterplc.com in Jun, 2018
Dr. Kelly Robinett a semi-retired emergency room doctor with more than 30 years of experience was convicted of fraud for his role in a $13 million home health care scam. After a weeklong trial before U.S. District Judge Reed O’Connor in Dallas, the jury issued its verdict after several hours of deliberations. Along with […]
Category: Anti-Kickback Statute, Medicare, News & Updates
Pfizer to Pay $23.85 Million for Alleged Violations of the Anti-Kickback Statute
Posted by donna@healthlawcenterplc.com in Jun, 2018
Pfizer was alleged to have used a tax exempt, non-profit foundation as a conduit to pay drug co-pays for Medicare patients who were either prescribed two Pfizer drugs for the treatment of renal cell cancer (Sutent and Inlyta) or another Pfizer drug for the treatment of atrial fibrillation or atrial flutter (Tikosyn). The Anti-Kickback […]
Category: Anti-Kickback Statute, Medicare, News & Updates
Post Tagged with Centers for Medicare & Medicaid Services, Fraud & Abuse, Medicare, Physician, The Health Law Center 
