Tag Archives: Billing

Surprise Medical Billing:  Bipartisan Consensus on the Problem, but Finding an Effective Fix May be Harder

In a rare display of unity, President Donald Trump and bipartisan Congressional leaders have highlighted their shared commitment to tackling “surprise” medical billing – when an insured patient is subject to unexpectedly high out-of-pocket costs for out-of-network care that is … Continue reading

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Sacramento Area Neurosurgeon Charged With Workers' Compensation Fraud and Insurance Fraud For Alleged Upcoding and Ghost Billing For Services Not Provided

On April 9, 2019, Dr. Laura Anderson, a neurosurgeon from Carmichael, California, was charged with multiple counts of medical insurance fraud, workers’ compensation fraud, and grand theft. A felony complaint is not evidence and Dr. Anderson is presumed innocent.The prosecution … Continue reading

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Federal Charges Can Come From Billing Private Health Insurance: San Francisco Acupuncturist Indicted On Health Care Fraud Charges For Alleged False Billing and Upcoding

We are seeing an increase in investigation of acupuncturists and chiropractors relating to billings to private insurance companies. The charges can result from upcoding, billing on the wrong dates, miscoding and other acts and omissions. There is a difference between … Continue reading

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Time for New Jersey Medical Practices to Update Certain Patient Disclosures and Comply with the Surprise Medical Billing Law

The New Jersey Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act (the “Law”), New Jersey’s “surprise” medical billing law, went into effect on August 30, 2018.  Among other things, it requires licensed health care professionals in New Jersey (including, … Continue reading

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New CMS Date of Service Coding and Billing Guidance Complicates Billing for Non-Global Radiology Claims

The Centers for Medicare & Medicaid Services (CMS) has issued new guidance on what date of service (DOS) should be billed for various Medicare Part B services.  For radiology services, CMS offers the option of reporting the DOS of either … Continue reading

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