Thomaston Pediatrician Pleads Guilty to Medicaid Fraud Kathy Mansfield, a Thomaston pediatrician and owner of Pediatric Associates of Thomaston, Inc., pled guilty yesterday to one count of Medicaid Fraud for intentionally overbilling the Medicaid Program in the amount of approximately $537,428. From 2003 to 2007, Mansfield billed Medicaid for the Synagis, a drug used to prevent […]

Proposed notices detail information insurance plans would have to give to consumers to justify rate increases over 10 percent Monday, the Centers for Medicare & Medicaid Services (CMS) published proposed consumer disclosure notices, required by the Affordable Care Act, that insurers would be required to complete and report electronically when they propose rate increases over […]

Region C List Riddled with Errors Two of the CMS Recovery Audit Contractors (RAC) posted newly approved issues last week to their public websites, as required by CMS before widespread review of those issues can begin. Connolly Healthcare, the RAC for CMS Region C posted 36 new issues on their Approved Issues webpage, on Wednesday, […]

Health care fraud prevention and enforcement efforts recover record $4 billion; new Affordable Care Act tools will help fight fraud Joint DOJ & HHS  efforts result in largest sum ever recovered in single year; new rules under the Affordable Care Act will keep fraudulent providers and suppliers out of Medicare, Medicaid, CHIP and avoid payments […]

Includes Stark Law issues and self-disclosure of E/M upcoding issues What lawyers call “technical” Stark violations can slam hospitals because of the black-and-white nature of the statute, a fact of life that hit home for Detroit Medical Center, which agreed to pay $30 million to resolve false claims allegations arising from sweetheart deals with referring […]

Physician Leases Self-disclosed in 2008 The former owner of the facility that was known as South Coast Medical Center (SCMC) in Laguna Beach, Calif., agreed to pay more than $72,000 in a civil monetary penalty (CMP) settlement concerning leases with providers. After it reported the problematic arrangements to HHS Office of Inspector General (OIG), the […]

MEDICARE IMPOSES MARKETING AND ENROLLMENT SUSPENSION ON THREE HEALTH AND DRUG SPONSORS PLAN VIOLATIONS RANGE FROM MARKETING TO RISKS TO HEALTH AND SAFETY OF MEMBERS The Centers for Medicare & Medicaid Services (CMS) today issued a notice to three Medicare health and drug plan sponsors imposing sanctions for violations of Medicare’s rules and regulations. This […]

New Demonstration Programs Support Innovation Center Goals The Centers for Medicare & Medicaid Services (CMS) today formally established the new Center for Medicare and Medicaid Innovation (Innovation Center). Created by the Affordable Care Act, the Innovation Center will examine new ways of delivering health care and paying health care providers that can save money for […]

CMS announces education effort to support program The Centers for Medicare & Medicaid Services (CMS) today [Friday, November 5, 2010] proposed new rules to help states reduce improper payments for Medicaid health care claims through the use of Medicaid Recovery Audit Contractors (RACs) as part of the Affordable Care Act’s larger strategy to crack down […]