Every year, CMS issues clarifications, additions and deletions to diagnosis codes that become effective on October 1, 2023. For 2024, CMS announced 395 new diagnosis codes, 25 deletions and 13 revisions. Although there are many changes in wording, synonyms and instructional notations, below are the most salient code changes but please note that this is not an exhaustive list. Do check CMS...
Florida-based Lincare Holdings has agreed to pay $29 million to settle allegations it overbilled Medicare and Medicare Advantage plans for oxygen equipment provided to patients with respiratory-related illnesses. The settlement, which is the largest ever healthcare fraud settlement in the Eastern District of Washington settles claims that Lincare violated the False Claims Act. Lincare Agrees to...
A case from North Carolina highlights what we see too often: healthcare entrepreneurs and providers committing fraud, paying monetary penalties and even facing incarceration. But rarely do we see the penalties travel down the ladder to a company’s employees. A pharmacy owner was sentenced to 24 months this month for conspiracy to commit fraud. Apparently, the pharmacy owner ran a scheme for 11...
A man who dubbed himself a “serial entrepreneur” is the target of a complaint alleging he violated the False Claims Act by submitting more than 24,000 false claims to Medicare for more than 300,000 respiratory pathogen panel tests that were not ordered by healthcare providers, not medically necessary, or never performed. The defendants billed and received more than $7 million in reimbursement...
In 1996, the Mental Health Parity Act required insurance companies to provide the same benefits for substance abuse and mental healthcare services as they do for ordinary medical care. In 2010, the Affordable Care Act imposed penalties for not providing such comparable coverage. Due to the expansion in requisite coverage, there has been an expansion in the number of addiction treatment...
Inadequate oversight by the Centers for Medicare & Medicaid Services (CMS) of payments for the highest paid genetic test risked up to $888 million in improper payments, according to a recent audit by the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG). OIG reviewed Medicare Part B claims for more than 450,000 genetic tests billed under CPT code 81408...
