Medicare

Published on: August 24, 2010

Michigan Doctor Sentenced to Prison for Medicare Fraud

The Detroit Free Press reported that a Michigan doctor was sentenced to 14 years in prison for Medicare fraud. In addition to the prison sentence, the doctor will owe $9.4 million in restitution payments and is eligible for a three-year supervised release after his prison sentence. According to the Department of Justice (DOJ), the doctor and a co-conspirator wrote prescriptions for controlled drugs in exchange for the patients’ Medicare numbers. The co-conspirator would then bill for fictitious rehabilitation and home health services using the Medicare numbers. Medicare reimbursed the conspirators $9.4 million for fake services.

For more information on Michigan healthcare legal news, or for assistance with a Medicare audit or investigation contact a Wachler & Associates attorney at 248-544-0888.

Published on: August 17, 2010

OIG Report Identifies Overpayments to Physicians for Incorrect Place of Service Codes

by Wachler & Associates, P.C.

The Department of Health and Human Services Office of Inspector General (OIG) published a report finding that Medicare contractors overpaid physicians an estimated $13.8 million for services provided during calendar year 2007 with incorrect place of service codes. The OIG report reminded physicians that they must identify the place of service on health insurance claim forms submitted to Medicare contractors. This is because physicians are reimbursed at different rates depending on where the services are performed.

In addition to its identification of common billing errors, OIG recommended that the Centers for Medicare and Medicaid Services (CMS) instruct its Medicare contractors to recover the overpayments found from the services OIG sampled for its report. OIG also encouraged the CMS to reopen nonsampled services to recover any overpayments and to continue its effort to educate physicians and billing services on the importance of identifying the place of service in Medicare billing records.

Providers should ensure that their billing practices follow the Medicare requirements, including proper place of service codes.

Published on: August 12, 2010

OIG LEIE Search Errors

by Wachler & Associates, P.C.

The Office of Inspector General (OIG) for the Department of Health and Human Services recently announced a discovery that during the time period from July 15, 2010 through August 4, 2010 the search/verification function on the online searchable List of Excluded Individuals/Entities (LEIE) was not working properly. Therefore, health care providers who conducted searches during this time period are advised to repeat the searches because it is possible that searches may have resulted in false negative results, i.e. individuals and/or entities that are actually excluded may have shown up as not excluded.

Medicare providers who contract with or employ excluded providers are subject to civil monetary penalties, nonpayment for services and possible exclusion themselves.

For more information regarding obligations to search the excluded providers list as well as other compliance issues, please contact a Wachler & Associates attorney 248-544-0888.