Medicare overpaid docs billions for office visits, OIG says

Medicare overpaid docs billions for office visits, OIG says

Tuesday, September 15, 2015

Did you know that according to the Health & Human Services Office of Inspector General, Medicare overpaid physicians $6.7 billion for evaluation and management services in 2010? The overpayments were caused primarily by incorrect medical coding and inadequate documentation. This represented more than one-fifth of overall payments issued for E/M services that year.Read More...

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APNewsBreak: Medicare bought meds for dead people

APNewsBreak: Medicare bought meds for dead people

Tuesday, September 15, 2015

Did you know that Medicare’s operating rules allow it to pay for prescription drugs up to 32 days after a patient’s death – not a best practice? About 80% of these prescriptions were filled at neighborhood pharmacies, reflecting criminals acquiring the drugs to presumably sell on the black market at a hefty profit. High-priced drugs tend to be painkillers and anti-anxiety drugs that are sought by people with substance-abuse issues....

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How doctors and hospitals have collected billions in questionable Medicare fees

How doctors and hospitals have collected billions in questionable Medicare fees

Tuesday, September 15, 2015

Did you know that Medicare compares each doctors’ proportion of various types of office visits (new patient encounter, established patient, etc.) to determine if they conform to the national profile for all providers? If they do not conform to the typical percentages, the medical providers could be at higher risk for being audited and sanctioned for “upcoding”. This is the practice of charging patients more for the office visit than is merited based upon the documented medical treatme...

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National Correct Coding Initiative Edits

National Correct Coding Initiative Edits

Tuesday, September 15, 2015

Did you know that the National Correct Coding Initiative (NCCI) is intended to promote national correct coding methodologies and to minimize improper coding leading to inappropriate payment? These coding policies were developed jointly by CMS and the American Medical Association's, and are updated annually to ensure the latest “best practices” are reflected. While originally developed for Medicare/Medicaid, it is used by many private payers to ensure proper & accurate coding and paym...

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Feds recovered $3.3 billion in healthcare fraud for 2014

Feds recovered $3.3 billion in healthcare fraud for 2014

Tuesday, September 15, 2015

Did you know that the federal government recovered $3.3 billion in healthcare fraud in fiscal 2014 per the Justice Department? This amounts to $7.70 for every dollar spent on healthcare-related fraud and abuse investigations over the last 3 years. In all, 734 defendants were convicted of healthcare fraud-related crimes last year. ...

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Doctors, nurses, others charged in $712M Medicare fraud bust

Doctors, nurses, others charged in $712M Medicare fraud bust

Tuesday, September 15, 2015

Did you know that in June 2015 the U.S. Justice Department conducted the largest ever crackdown on Medicare fraud, filing charges against 243 people covering $712 million in false billings to Medicare? Among those charged over the past several days are 46 doctors, nurses and other medical professionals as well as others accused of health-care fraud, violations of anti-kickback statutes, money laundering and identity theft....

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ICD-10 And Cost Of Care Transparency Among Leading Issues For Physicians In 2015

ICD-10 And Cost Of Care Transparency Among Leading Issues For Physicians In 2015

Tuesday, September 15, 2015

Did you know that the migration to ICD-10 and the cost of care transparency are among the leading issues for physicians in 2015? The ICD-10 migration will see the diagnosis codes grow from about 18,000 numeric codes to over 140,000 alphanumeric codes. While it will provide greater granularity in terms of disease management, it will likely cause significant disruption and billing issues in the short-term....

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Why Is There So Much Unnecessary Care?

Why Is There So Much Unnecessary Care?

Tuesday, September 15, 2015

Did you know that Walmart is receiving unexpected benefits from its leading edge program for medical "centers of excellence"? Walmart is sending employees to chosen "centers of excellence", and is finding that 30% of the transplants initially recommended are not necessary.Read More

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9 New York Doctors Are Accused of Defrauding Medicaid Using Homeless People

9 New York Doctors Are Accused of Defrauding Medicaid Using Homeless People

Tuesday, September 15, 2015

Did you know that 9 New York doctors are indicted in March 2015 on Medicaid fraud using homeless people as patients? The doctors offered free shoes as an inducement to be subjected to a raft of unnecessary medical tests and equipment prescriptions. These tests led to $7 million in false Medicare and Medicaid billings between 2012 and 2014. ...

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What Is A Medical Loss Ratio? The Check Will Be In The Mail

What Is A Medical Loss Ratio? The Check Will Be In The Mail

Tuesday, September 15, 2015

Did you know that Medical Loss Ratio is arguably the single most important financial measure in the healthcare world? For an insurance company, it represents how much of the annual premiums goes toward medical expenses versus marketing, administration and insurance company profit. It is now legislatively limited to 20% on small company plans and 15% on large company plans....

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