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December 2019 Archives

DOJ charges Texas billing clerk with health care fraud

The United States Department of Justice (DOJ) continues its focus on health care fraud investigations involving National Football League (NFL) players. The agency recently announced another round of criminal charges. As discussed in a recent post, the agency indicted ten players earlier this month for health care fraud crimes. This round of criminal charges involves a billing clerk that was allegedly affiliated with a health care fraud scheme that involved another, former NFL player.

DOJ accuses football players of health care fraud

The United States Department of Justice (DOJ) recently announced it will pursue charges against ten former players for the National Football League (NFL). The government has accused these professional athletes of partaking in a scheme to file false and fraudulent claims for medical equipment.

Will tech innovations help address nursing shortage in TX?

Texas and states throughout the country are in the midst of a nursing shortage. The problem is so serious, that the dean of the Texas A&M College of Nursing recently testified before a U.S. committee. The testimony included a discussion on innovations within academic nursing. Hospitals throughout the state are struggling to find nurses to provide quality care to patients. According to this educational leader, one potential answer to this shortage is increased reliance on technological innovations.

Successful Appeal - Medicare Overpayment Reduced by Over 3.3 Million

Recently, a Medicare certified home health agency received a letter from CMS alleging that the home health agency received an overpayment in the amount of $3,351,149.00. Rivas Goldstein, LLP prepared a Redetermination appeal that contested the overpayment by arguing that the extrapolation methods utilized by CMS were not conducted in accordance with Medicare guidelines and argued that the services rendered were medically necessary and met Medicare guidelines. As a result of the Request for Redetermination submitted by Rivas Goldstein, the amount of the overpayment was reduced from $3,351,149.00 to $55,538.52.

Texas Board of Nursing warns nurses of phone scam

The Texas Board of Nursing (BON) recently released a statement warning nurses throughout the state of a current telephone scam. According to the group, fraudsters who are part of this scam will contact those who hold a nursing license and demand money. The demand, the fraudster will argue, is due to an impending investigation by the BON. The fraudster may then claim the nurse is required to make the payment cover the cost of the investigation or to pay a fine.  

How does the claim CMS overpaid $500 million affect your practice?

The United States Health and Human Services Department (HHS) Inspector General states the Centers for Medicare and Medicaid Services (CMS) overpaid claims by $502 million from 2011 through 2014. The error was allegedly due to a malfunction in the outlier payment review process.

TX physicians take note: New law may impact health care billing

The Texas Legislature has recently proposed a new rule that will limit health billing options. Lawmakers state the new law, scheduled to go into effect January 1, will help protect patients from surprise medical bills. But medical professionals have voiced concern the law may have unintended, negative consequences for patients.

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