Tag Archives: Medicare

After 6 Week Trial, New York Doctor And Physical Therapist Found Guilty Of Health Care Fraud, Conspiracy to Make False Statements Relating to Health Care Programs Medicare And Medicaid and Other Counts With Allegations of Sham Owner, Falsified Medical Records, Kickbacks.

A recent health care fraud case involved the alleged unlicensed practice of medicine and a  physician allegedly posing as the owner of medical clinics in order to satisfy New York  law that medical clinics be owned and operated by a medical … Continue reading

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2019 Social Security and Medicare Trustees’ Reports Issued; Reports Sound Alarm (Again) as Depletion of Trust Fund is Imminent

Each year, the board of trustees of the Social Security Trust Fund and Medicare Trust Fund release reports to Congress providing an estimated projected financial outlook for the programs.  Last week both reports were released.  The 79th annual Social Security … Continue reading

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California Business Partners in Home Health and Hospice Businesses Sentenced To 33 Months In Federal Health Care Fraud Case. One Partner Was Previously Excluded From Medicare By OIG.

Home health and hospice fraud cases are still priorities in the Justice Department. On April 18, 2019, a former California medical doctor Camilo Q. Primero, age 76, and his business partner Aurora S. Beltran, age 63,were sentenced to 33 months in prison … Continue reading

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Sutter Health LLC, a Medicare Advantage Provider, Pays $30 Million To Settle Alleged Overpayment Based on Beneficiaries' Health Status Risk Scores

It is not just fee-for-service providers that have audits and civil qui tam cases. Managed healthcare is facing review as well. Even providers who are paid capitation fees should be mindful of the codes submitted to managed care. A recent … Continue reading

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CMS Proposes $887 Million Boost in Medicare Payments to Skilled Nursing Facilities in FY 2020 While Floating Expanded Group Therapy Definition

The Centers for Medicare & Medicaid Services (CMS) recently released its 232-page proposed rule to update the Medicare skilled nursing facility (SNF) prospective payment system (PPS) for federal fiscal year (FY) 2020, which begins on October 1, 2019. Overall, CMS … Continue reading

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