Ride along with Mark as he questions who’s accrediting the accreditors, even the biggest one of all, the Joint Commission.
Tag: fraud
Payor Agreements and Hidden False Claims Act and Criminal Traps
It was a neighborhood like many others. Neat, but not too neat front yards. Newspapers brought in by 8:00 a.m. and maybe by 10:00 a.m. on weekends. And, all was within the bounds of normal, giving, of course, wide birth to the meaning of the word, for this is nonfiction, not fiction. But with one…
Extrapolation: How the Government Turns One Alleged Bad Claim Into Thousands of Violations
Compliance. Ah, what a funny world we live in. Government regulators at the SEC force those offering investment opportunities to issue disclaimers that past performance is not indicative of future results. Extrapolation is bad. Yet a few miles away, other government regulators at the OIG alchemize a handful of discovered violations into thousands more. Extrapolation…
21 Doctors, Plus Pharmacists and Practice Managers, Charged in $40 Million Kickback Scheme
Last week, the California Insurance Commissioner and the Orange County District Attorney shut down a $40 million fraudulent medical billing and kickback operation by filing criminal charges against 21 doctors plus 5 others: pharmacists and purported “medical group management company” owners. Involved are Tanya Moreland King and her husband Christopher King, the owners of medical…
Office Sharing: Turning Share Mates Into Cell Mates – Podcast
Office-based specialists, from ENT’s to urologists, often enter into suite sharing arrangements. No problem! That is, until they make it one.
Bean Counters 1, Patients 0 – Podcast
Measurement of “care” will soon count for more than care itself.
The Devaluation of Value-Based Billing
“Value based billing” remains dominant in the medical industry news, chiefly from the MACRA angle. Mostly, though, it’s a lie because value is determined by the customer, not by some bean counter at CMS. Sure, CMS may be paying the bill for Medicare patients, but the patients are the actual customers and only they can assess whether value was truly delivered.
Aetna Obtains $37 Million+ Judgment Against ASC Manager – Podcast
Earlier this year, a Santa Clara County, California jury awarded the insurer Aetna a $37,452,199.00 judgment in a lawsuit against Bay Area Surgical Management, LLC, a surgery center management company, a number of its managed ASCs, and three of Bay Area’s executives.
Aetna Obtains $37-plus Million Judgment Against ASC Manager
This past Friday, April 15, 2016, a Santa Clara County, California jury awarded the insurer Aetna a $37,452,199.00 judgment in a lawsuit against Bay Area Surgical Management, LLC, a surgery center management company, a number of its managed ASCs, and three of Bay Area’s executives. The ASCs were out of network as to Aetna plans….
Office Sharing: Turning Share Mates Into Cellmates – Medical Group Minute
Office-based specialists, from ENTs to urologists, often enter into suite sharing arrangements. No problem! That is, until they make it one. Watch as Mark delves into the unintended consequences of improperly structured office-sharing arrangements.