Posts Tagged ‘medicare’
Complex healthcare fraud scheme boils down to two things — money and jail.
HARRISBURG – The United States Attorney’s Office for the Middle District of Pennsylvania announced that Rodney L. Yentzer, age 55, formerly of Carlisle, Pennsylvania and currently in Chuluota, Florida, was sentenced to 42 months imprisonment on charges of conspiracy to commit health care fraud, conspiracy to commit money laundering, and theft of public money. He…
Read MoreNursing Home Admin Steals Elderly Residents, Deceased Residents’ Estates for Her Own Financial Benefit
Mia Hardy, 58, was arrested and charged by indictment with eight counts of wire fraud, arising from an alleged scheme to defraud the residents of two senior living facilities, residents’ heirs, and the facilities themselves. Hardy was employed first at Living Facility #1 and Senior Living Facility #2. Both used a resident fund management service…
Read MoreMedicare, Medicaid & Payer Audit Requests Payers are auditing claims at an increasing rate. Be prepared! Have a process
Medicare, Medicaid & Payer Audit Requests Payers are auditing claims at an increasing rate. Be prepared! Have a process to ensure the packets are reviewed and completed before submission. Here are a few tips to stay prepared: Attach copies when you bill a code Monitor the time frame it takes to gather records You CAN…
Read MoreHOSPITAL CEO PLEADS GUILTY TO FRAUD WHILE FINANCIAL OFFICER AT PRIOR JOB
Its amazing the creativity and gall of people in control of the bank accounts and bill paying mechanism at corporations. “Prosecutors say Mr. MacGregor defrauded his former employer, which is identified in the documents as a company that “provided medical laboratory directorship and pathology services to hospitals and clinics and operated an independent lab.” He…
Read MoreCMS audit and claw back of $2 Billion denied by federal master.
A federal judicial master’s critique of CMS’ audit case against a health insurer, “A mere possibility of an overpayment is not enough for the government to carry its burden.” The problem with the government’s allegations is that the government knew of the very chart review practices which it now claims United prevented it from learning,…
Read MoreAct 53 of 2020…. Time for Reinstatement
We all know that a felony Drug Act conviction requires the healthcare boards in Pennsylvania to suspend a license for 10 years. https://phila-criminal-lawyer.com/drug-act-issues/felony-drug-convictions/ However, in 2020, a new law came into effect. Act 53 of 2020 provides that “the addition of [Section 3113] … shall apply to official acts and matters, including disciplinary matters, related…
Read MorePhysician – not Physician’s Assistant – Must See Patients
A St. Louis physician plead guilty in August 2024 to one count of conspiracy. He admitted that while operating St. Louis General Hospital locations in the city and Creve Coeur, Mo., he and his office manager hired assistant physicians (“APs”) to see patients but billed federal healthcare programs as if he had seen them. He…
Read MoreRuan and How the Courts and Prosecutors are Managing it
Translating this case into my client’s legal defense is easy. Having handled many physician prescribing prosecutions, long-term physician patient relationships are easily documents through chart reviews. Medically appropriate prescriptions can only be proven through clear charts, well documented and proper physical examinations, objective medical tests and diagnostic imaging. Call me to discuss your case, your patient load, your prescribing history, any state or federal DEA investigatory subpoenas. Lets talk about debarment, public or private health insurance audits and claw backs for care properly rendered and medically necessary.
Read MoreKeystone Health Plan East, random pharmacy insurance audits for medicare/medicaid. Scary, extensive, and expensive.
Intrusive, expensive, and time consuming audits. Lets talk really about what these audits are.
Read MoreDAUPHIN COUNTY ARD RULES CHANGE DURING COVID
Ard rules for Dauphin County
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