Coverage by medical insurance is important for more than just patients—it is also important for those who operate in the health care industry. Businesses that operate in this market often depend on payments from insurance companies to continue operations. Without payment for the services provided, the business may not receive the funds it needs to operate.
The Recovery Audit Contractor Program is one group that contracts with the government ot correct inaccurate Medicare payments. Those who disagree with the program’s findings can appeal the process. However, one of the biggest critiques of the appeals process is the length of time it takes to reach a resolution. As of February 2015, the appeals process took an average of 572 days.
The Southern District of Texas recently accused a Texas pharmacy owner of an elaborate health care fraud scheme. During the investigation, the prosecution gathered evidence to support allegations a city official was also involved in the scheme. The accusations were serious and included involvement in an alleged scheme to receive over $1.7 million in false payments from Blue Cross and Blue Shield of Texas.
Psychiatric facilities must operate while maintaining a difficult balance: provide the care patients need while not discharging them at a time they could injure themselves or others. A failure to navigate this balance wisely can result in allegations of criminal wrongdoing.
Navigating the intricacies of insurance payments is difficult, even for hospital officials. One local hospital is attempting to figure out what went wrong that led to an insurance company accusing the hospital of fraudulent billing practices.
The Department of Justice continues to crack down on allegations of bribery in the healthcare industry. In the latest case, the government accused a Texas surgeon of paying and receiving bribes in relation to his medical practice.
Lawmakers recently passed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) Act. This proposal passed with bipartisan support and was signed into law by President Donald Trump on October 24, 2018. The SUPPORT Act will have a major impact on healthcare throughout the country.
A sheriff’s department in Texas has charged two office administrators at medical clinics with healthcare fraud. The state has accused the women of conspiring with a doctor at the clinic to file fraudulent claims with the Office of Worker’s Compensation.
Allegations of wrongdoing can haunt the accused for the rest of his or her life. This is particularly true when the allegations involve government allegations of breaking the law. Is it possible to overcome these allegations and move on to live a successful and fulfilling life? In short, the answer is yes, but the road to success is a difficult one. A recent political battle provides an example.
The Department of Justice (DOJ) continues to crackdown on allegations of healthcare fraud. The agency’s most recent examples a psychologist and his wife who ran a psychological practice. The government has accused the couple of partaking in an elaborate billing scheme to defraud Medicaid.