Owner of Texas Behavioral Health Counseling Clinic Pleads Guilty to Medicare Fraud
(June 5, 2010): Early last week, the U.S. Attorney’s Office in Houston, Texas announced that a plea agreement had been reached with the owner of a behavioral counseling center in Houston. The owner pled guilty to (1) conspiracy to commit health care fraud, (2) health care fraud and (3) aggravated identity theft, all arising out of the defendant’s alleged role in a health care fraud scheme in which Medicare and Medicaid were fraudulently billed for psychiatric counseling services. According to the government, the owner of the behavioral counseling company misrepresented himself as a doctor in psychology (Ph.D.) when, in fact, he ...
Responding to a Search Warrant of Your Practice or Clinic.
I. Introduction: Like most honest health care providers, you may believe that “search warrants” are only executed by the government in connection with the investigation of nefarious characters and criminals. Unfortunately, that just isn’t the case. The Federal government has increasingly utilized search warrants as a first-strike investigative tool. In fact, the execution of a search warrant may very well be the first notice a health care provider has that their practice or clinic is under investigation. Allegations of wrongdoing may arise from a wide variety of sources. Health care providers may have been reported by disgruntled current or former employees, dissatisfied ...
Senator Grassley Proposes Bill to Fight Fraud, Waste and Abuse in Medicare and Medicaid
On January 28, 2010, Senator Chuck Grassley (R-IA) introduced a wide-ranging bill to fight fraud, waste and abuse in Medicare, Medicaid and the Children’s Health Insurance Program. “This bill brings together common sense, bipartisan initiatives to fight fraud, waste and abuse in taxpayer-sponsored health care programs, which all face serious budgetary challenges,” Senator Grassley said. He further noted that as spending on these programs continues to grow, Congress should act quickly to pass these reforms out of respect for taxpayers and on behalf of program beneficiaries. Grassley said his bill includes provisions that would: Deter fraud with enhanced screening to improve the government's ...
Medicaid Integrity Contractors (MICs): Getting Ready for the Latest Group of Auditors Seeking to Review Your Claims
Our clients diligently work to ensure that their coding and billing practices comply with applicable statutory and regulatory requirements. Nevertheless, over the last decade, many providers have been subjected to costly, extensive post-payment audits of Medicare claims conducted by Program SafeGuard Contractors (PSCs). Over the last year, PSC audits have been steadily replaced by Zone Program Integrity Contractors. (ZPICs). Unlike audits conducted by Recovery Audit Contractors, these PSC / ZPIC audits have not been restricted in terms of how far back they can go. In a recent case initiated last year, a PSC issued a demand letter covering physical therapy ...
HHS-OIG Enters Into Civil Monetary Penalties Settlement with Former Hospital Executive Director / Compliance Officer
The former Executive Director (and Compliance Officer) for a West Coast hospital has recently entered into a civil monetary penalties settlement agreement with the Office of Inspector General for the Department of Health and Human Services (HHS-OIG). He has reportedly paid $64,000 to resolve allegations that, as Executive Director and Compliance Officer of the facility, he violated the Civil Monetary Penalties Law and the civil monetary provisions of the physician self-referral (Stark) law. This settlement with the former hospital administrator stems from the same conduct that resulted in the hospital paying a $1.5 million settlement to the Federal government in December ...
National Summit on Health Care Brings Private and Public Sectors, Law Enforcement Together to Fight Fraud
Attorney General Eric Holder and United States Department of Health and Human Services Secretary Kathleen Sebelius today joined private sector leaders, law enforcement personnel and health care experts for a milestone National Summit on Health Care Fraud. The summit is the first national gathering on health care fraud between law enforcement and the private and public sectors and is part of the Obama Administration's coordinated effort to fight health care fraud. "Health care fraud affects all Americans and demands a coordinated, national response," said Attorney General Holder. "HEAT (the Health Care Fraud Prevention & Enforcement Action Team) has proven that better ...
Medicaid Audits
Senator Grassley Proposes Bill to Fight Fraud, Waste and Abuse in Medicare and MedicaidOn January 28, 2010, Senator Chuck Grassley (R-IA) introduced a wide-ranging bill...
Medicaid Integrity Contractors (MICs): Getting Ready for the Latest Group of Auditors Seeking to Review Your ClaimsOur clients diligently work to ensure that their coding and billing practices comply...
Read More Posts From This CategoryFalse Claims Act
Senator Grassley Proposes Bill to Fight Fraud, Waste and Abuse in Medicare and MedicaidOn January 28, 2010, Senator Chuck Grassley (R-IA) introduced a wide-ranging bill...
Read More Posts From This CategoryMedicare Audits
Owner of Texas Behavioral Health Counseling Clinic Pleads Guilty to Medicare Fraud(June 5, 2010): Early last week, the U.S. Attorney’s Office in Houston, Texas announced that a plea agreement had been reached with the owner of a behavioral counseling center in Houston. The owner pled guilty to (1) conspiracy to commit health care fraud, (2) health care fraud and (3) aggravated identity theft, all arising out of the defendant’s... [Read more of this review]
Responding to a Search Warrant of Your Practice or Clinic.I. Introduction: Like most honest health care providers, you may believe that “search warrants” are only executed by the government in connection with the investigation of nefarious characters and criminals. Unfortunately, that just isn’t the case. The Federal government has increasingly utilized search warrants as a first-strike investigative... [Read more of this review]
National Summit on Health Care Brings Private and Public Sectors, Law Enforcement Together to Fight FraudAttorney General Eric Holder and United States Department of Health and Human Services Secretary Kathleen Sebelius today joined private sector leaders, law enforcement personnel and health care experts for a milestone National Summit on Health Care Fraud. The summit is the first national gathering on health care fraud between law enforcement and the... [Read more of this review]
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