If we could call it upcoding, it would be an understatement to call it upcoding to infinity.
Healthcare Fraud
Fraud on Fridays: Fraud on Physicians in the ASC Setting
When you think about fraud at an ASC, you tend to think about fraud on payers, from Medicare to well, Blue Cross. You know, cases that never happened, patients who didn’t suffer from any medical issue, and the like. But what about fraud on physicians at an ASC? Because physicians hardly think about it, it…
Fraud on Fridays: $10.6 Billion – Does Crime Pay?
In a healthcare billing and payment system that’s so complex, it’s sad to say that criminals can stay a few steps ahead of the Feds. With $10.6 billion in bogus billing, some cutouts got caught, but the masterminds appear to have escaped with close to $1 billion.
Fraud on Fridays: The Four Legs of Fraud
The DOJ kicked back when it secured a conviction against compounding pharmacy executive Sam Glover for a six-year drug alteration and misbranding conspiracy involving free flowing prescription forms and, well, racehorses.
Fraud on Fridays: The Case of Dr. Jorge Zamora-Quezada
Dr. Jorge Zamora-Quezada, a Texas rheumatologist, was sentenced earlier this year to ten years in federal prison for a healthcare fraud so brazen it left even seasoned prosecutors shaking their heads. Read the full DOJ press release.
The BS MSO: Kickbacks Disguised as Investments Snare Another Round of Settlements
The Department of Justice just announced more than six million dollars in settlements with a former lab CEO, seven marketers, and two physicians. Their alleged wrong? Turning the concept of the “Management Services Organization” into a pay-to-play operation.
$500 Million in Alleged Phony Charges and the Dangers of Medical Directorship
A $500M medical directorship fraud case exposes how physicians can be exploited. Protect your practice from legal and financial fallout.
Double Trouble: Prosecuted and Sued for the Same Scam
Out of state. Still billing for in-person care.
A physician submitted claims while vacationing in Hawaii—and now faces criminal sentencing and a $500k civil payout.
Healthcare Fraud and the Physician as Victim
The majority of healthcare fraud schemes center on fraud perpetrated by physicians, but what about schemes orchestrated to victimize physicians?
The Nation’s Largest Health Care Fraud Bust, Plus Bureaucratic Negligence
It’s been said that people read published lists of disciplined fellow professionals out of a sense of schadenfreude, the pleasure derived from another’s misfortune.