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A Home Health Provider Agrees To Pay $22.9 Million In False Claims Act Case

Home Health Care

million in order to resolve allegations that it paid physicians to induce referrals of patients that led to false claims to the Medicare and TRICARE programs. The company’s former CEO Stanley Carter and COO Brad Carter have agreed to no longer participate in Medicare, Medicaid and all other federal health care programs for five years.

Tricare 104
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NASHP Model Act to Limit Out-of-Network Provider Rates

NASHP

This model legislation limits out-of-network rates for inpatient and outpatient hospital services to the lesser of (a) the state’s median in-network commercial rate for the same service; or (b) [X]% of the Medicare rate for the same service in the same geographic area. X]% of the amount paid by Medicare for the same item or service; or.

Insiders

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How to Bill Insurance Companies for Counseling: 5 Easy Steps

Etactics

Thus, if you’re not credentialed with Medicare, Medicaid and Tricare, the claims you submit to any of those providers will result in an automatic denial. Of course, if payment comes via an EFT, it will just appear in your organization’s bank account with no real explanation. Claim status.

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Sick Profit: Investigating Private Equity’s Stealthy Takeover of Health Care Across Cities and Specialties

KHN

The pain clinics also overcharged Medicare by billing up to $1,100 for “unnecessary and often worthless” back braces and charging up to $1,800 each for urine drug tests that were “medically unnecessary and often worthless,” according to the suit.

Doctors 145
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Sick Profit: Investigating Private Equity’s Stealthy Takeover of Health Care Across Cities and Specialties

KHN

The pain clinics also overcharged Medicare by billing up to $1,100 for “unnecessary and often worthless” back braces and charging up to $1,800 each for urine drug tests that were “medically unnecessary and often worthless,” according to the suit.

Doctors 52
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Exposing Healthcare Fraud with Jonathan Tycko| E. 68

Vie Healthcare

And as you know, obviously a huge percentage of healthcare spending is funded through Medicare, Medicaid, Tricare, the VA system, and these are all programs that are covered by the False Claims Act. All this really affects clinicians.