Temple University agreed to pay $100,000 to settle claims that it overbilled Medicare and Medicaid for neurology services. The settlement agreement covers alleged overbilling for services provided by Temple University physicians at the university’s own facilities and at Frankford Hospital. According to the government, the university submitted claims to Medicare and Medicaid using codes that resulted in higher payments for services than the codes that should have been used based on the medical documentation supporting the services. Using a higher billing code than the documentation supports is known as “upcoding.” After reviewing the government’s allegations and the underlying documentation, the university agreed that the coding was not accurate. Upcoding is just one type of billing practice that results in Medicare and Medicaid paying more for services than they should. Healthcare providers can be charged with upcoding when they use the wrong code or when the documentation supporting the claim for reimbursement is inadequate to justify the code that was used. Other improper billing practices include “unbundling” and “double billing.” Unbundling involves charging separately for services and procedures that should be billed under a single billing code. Double-billing occurs when a healthcare provider bills both government programs and either private insurers or patients. Upcoding, unbundling, and other types of improper billing practices are serious violations of the federal False Claims Act. They can result in treble damages and penalties of $11,000 for each claim submitted to the government. But these billing practices are often difficult to detect. That is why the government pays whistleblower rewards to individuals who come forward with evidence of improper, false or fraudulent claims. Under the federal False Claims Act, an individual who helps the government stop Medicare and Medicaid fraud and abuse is entitled to a whistleblower reward of between 15% and 30% of the amount the government recovers. These whistleblower rewards can amount to tens of thousands of dollars, hundreds of thousands of dollars, and in some cases millions of dollars. If you are aware of false or improper claims submitted to Medicare or Medicaid, then you should consult with an experienced whistleblower attorney. You may be entitled to a substantial whistleblower reward and legal protections under the False Claims Act. To arrange a free and confidential consultation with an experienced whistleblower attorney, call John Howley, Esq. at (212) 601-2728 or click here to reach our offices via email. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules.
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When prosecutors indicted the owner of a dental practice for Medicaid fraud, they also indicted his office manager, billing manager, and four dentists employed by the practice as co-conspirators in the fraud. Stephen Beukas is a dentist and former owner of New Jersey Mobile Dental Practice, P.A. (”NJ Mobile”). Dentists working for NJ Mobile provided on-site dental treatment to patients at nursing homes, assisted living facilities, adult day care facilities, and private homes. The government alleges that NJ Mobile submitted more than $5 million in false claims to Medicaid by:
As is typical in dental fraud cases, the government did not just arrest the dentist who owned the practice. The government also indicted the office manager, billing manager, and other employees as co-conspirators for going along with the fraud. These employees now face felony fraud charges that could result in long prison sentences and hefty financial penalties. It is too early to tell whether the dental office employees were innocent rubes or willing co-conspirators. But if they knew that false claims were being submitted to Medicaid, they had a number of options that might have avoided the criminal charges they now face. One option was to consult with an experienced whistleblower attorney about the rewards and legal protections available under the state and federal False Claims Acts. Under the federal False Claims Act, an individual citizen may bring a qui tam lawsuit on behalf of the government and share in any recovery. The lawsuit is initially filed “under seal” (in secret), and the evidence is provided only to the prosecutor. The prosecutor then investigates the case and decides whether to take it on. The whistleblower who brings the case is entitled to a reward of between 15% and 30% of the amount recovered. They are also entitled to legal protections against retaliation. The amount of the whistleblower reward depends on the amount actually recovered by the government. In this case, if the government recovered $5 million, then the whistleblower reward would be between $750,000 and $1.5 million. Do not go to prison for your employer’s fraud. If you know that false claims are being submitted to Medicare or Medicaid, consult with an experienced whistleblower attorney immediately to protect your rights, your livelihood, and your freedom. The consultation is free and confidential. No attorneys’ fees are charged unless you win. To arrange a free consultation with an experienced whistleblower attorney, call John Howley, Esq. at (212) 601-2728 or click here to reach us via email. We will listen to you, explain how whistleblower rewards work, advise you on your rights, and explain your options. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. A physician and his professional corporation agreed to pay $700,000 to settle allegations that false claims were submitted to Medicare for physician services at nursing homes. The government alleged that the physician’s medical records did not support his claims for Medicare reimbursement. The patient records did not contain the detailed history, examination, and medical decision-making documentation necessary to justify reimbursement. In some instances, there was no documentation at all. The government also alleged that the patient records did not accurately describe where the treatment was rendered. In some instances, the physician's records indicated that services were provided to patients in nursing homes, while other records indicated that the patients had been transferred to local hospitals for treatment. Claims submitted to Medicare or Medicaid must be supported with proper documentation. The patient records must establish that the treatment met the Medicare "medical necessity" requirements and was actually provided by the appropriate medical professional. Absent that documentation, the claims may be considered “false claims” under the federal False Claims Act, even if the services were actually provided and medically necessary. False Claims Act penalties include liability for three times the amount the government paid, plus $11,000 per claim. If the government can prove that the submission of false claims was intentional, it may pursue criminal charges that can result in up to five years in prison, hefty fines, exclusion from Medicare and Medicaid, and loss of professional licenses. If you are being investigated or have been charged with filing false claims to Medicare or Medicaid, then you should consult with an experienced Medicare and Medicaid fraud attorney immediately to protect your rights, your license, and your livelihood. Do not speak with the government until you have retained an experienced lawyer on your side. To arrange a free and confidential consultation with an experienced Medicare and Medicaid fraud attorney, call John Howley, Esq. at (212) 601-2728 or click here to reach our office via email. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. A dentist has been sentenced to 18 months in federal prison after pleading guilty to billing Medicaid for dental services that were not provided. Robin Lockwood, D.D.S. was employed by Ocean Dental, a chain of 30 dental clinics operating in seven states. Ocean Dental states on its web site that providing dental care to low income patients covered by Medicaid is an important part of its mission. Each state is required to provide certain basic dental benefits to children covered by Medicaid, including relief of pain and infections, restoration of teeth, and maintenance of dental health. Dental benefits for adults are covered by Medicaid only if the state chooses to provide such coverage. Lockwood was charged with one count of health care fraud earlier this year. The fraud charges carried a maximum sentence of 10 years in prison and a $250,000 fine. The government alleged that she falsified treatment notes submitted by Ocean Dental for Medicaid reimbursement. She benefited from the scheme because she received a percentage of the reimbursement for her services. The government also alleged that Lockwood billed for multi-surface fillings that she did not complete, upcoded bills to receive a higher reimbursement rate than the procedures justified, and billed for services not reimbursable by Medicaid by using a different billing code. According to the government, patient x-rays and other evidence established that Lockwood was creating false claims for submission to Medicaid. If you are being audited or investigated, or if you have been charged with submitting false claims to Medicaid, then you should consult with an experienced Medicaid fraud attorney immediately. To arrange a free and confidential consultation by phone or in person, call my office today at (917) 652-6504 or click here to contact me via email. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. The Centers for Medicare & Medicaid Services (CMS) report that healthcare recovery auditors (RACs) collected $2.3 billion in overpayments from providers in fiscal year 2012. The recovery of overpayments sets a new record that is almost three times more than the $800 million in overpayments recovered in the prior year. RACs also identified almost $100 million in underpayments. The Medicare Recovery Audit Contractor (RAC) program is designed to identify improper Medicare payments - both overpayments and underpayments. RACs are paid on a contingency fee basis, receiving a percentage of the improper overpayments and underpayments they collect from providers. Audits may cover up to the prior three years of provider claims. The scope of the audit may include ambulance, durable medical equipment, hospital inpatient and outpatient, laboratory, physician, and skilled nursing facility services. Payment errors often involve duplicate payments, fiscal intermediaries' mistakes, medical necessity, and coding. While many RACs have focused primarily on hospitals, American Medical News reports that CMS will direct the auditors' scrutiny of physician practices as well. The specific targets for these audits will include the so-called high-level patient evaluation code. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. |
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