Disproportionate Share Hospital (DSH) fraud in serving underprivileged patient populations Real-world examples of hospital fraud include: In Virginia, a hospital was billing for hospital outpatient procedures using codes reserved for physician’s office visits instead of an outpatient procedure performed at...
Discusses the lobbying efforts of the American Hospital Association on how investigations of healthcare facilities suspected of Medicare billing fraud should be conducted. Case of the Woods Memorial Hospital District in Etowah, Tennessee; Use of the False Claims Act in punishing healthcare fraud; ...
Governments worldwide are facing growing pressure to increase transparency, as citizens demand greater insight into decision-making processes and public spending. An example is the release of open healthcare data to researchers, as healthcare is one of t
36 Healthcare Fraud Cases The Columbia Presbyterian Division paid $480,000 in 2003 for improper billing as well as upcoding Supplementary data Clicks the Read More link to get more information Columbia's Defense and Charge H. Speken; and (2) compelling the plaintiff Ralph H. Speken to appea...
Berntsen’s litigation estimates the total amount of overbilling at $50 million, an amount that now could result in a significant financial payoff for her — and potentially large damages against the company. Advertisement Anti-fraud statutes allow fines of $5,500 to $11,000 — plus triple ...
If you would like more information on what it means to be a whistleblower or think you may have information relating to healthcare fraud or any other kind of government contract fraud, please feel free to contact us so we can connect you with a member of the Constantine Cannon whistle...
Matthew Bayley, MD; Sarah Calkins; Ed Levine, MD; and Monisha Machado-Pereira Fifteen cents of every US healthcare dollar goes toward revenue cycle inefficiencies.1 Of the $2.7 trillion the country spends annually on healthcare, $400 billion goes ...
In one hospital, for example, a practitioner discovered that the billing department was changing the primary, secondary, and tertiary diagnoses of DSM Axes I and II cases so that the patient would qualify, though not ethically nor legally, for more favorable funding coverage. The changes occurred...
“Of course, this phenomenon is not just dependent on the machine logic alerting, but is also subject to clinician education, documentation, coding and billing variables,” he explained. “But since we only recently began to adjust some of the machine logic parameters, it seems more likely ...
Los Angeles hospital CEO pleads not guilty to billing fraudAP/Yahoo News