Missouri hospital allegedly fired coder for refusing to ignore improper billing
A medical coder sued Mosaic Life Care Medical Center in St. Joseph, Mo., May 25 for wrongful discharge, unlawful retaliation and age discrimination.
The medical coder, Debra Conrad, alleges Mosaic Life Care fired her for disclosing the hospital’s fraudulent billing practices.
In April 2017, hospital officials allegedly instructed Ms. Conrad to begin releasing charges for billing even if the claims were not supported by documentation.
The medical coder, Debra Conrad, alleges Mosaic Life Care fired her for disclosing the hospital’s fraudulent billing practices.
In April 2017, hospital officials allegedly instructed Ms. Conrad to begin releasing charges for billing even if the claims were not supported by documentation.
“Plaintiff was instructed to push multiple charges through that may or may not be correct based on the current state of documentation, and such charges would consequently induce payment by Medicare and other third parties,” states the complaint.
Ms. Conrad alleges she told her supervisors the hospital could potentially face significant fines under the False Claims Act if the claims were released. Ms. Conrad processed the charges, but she included notations stating her supervisors authorized the release of what she believed were fraudulent claims, according to the report.
In May 2017, Ms. Conrad was moved to a coding position in a different department, and someone 15 years younger replaced her. The hospital also took disciplinary actions, including a brief suspension, against Ms. Conrad because she opposed the fraudulent billing, according to the lawsuit.
After complaining about the disciplinary actions, Ms. Conrad had a meeting with human resources and coding department management. She was subsequently accused of violating HIPAA.
“Merely because plaintiff could see patient information while performing duties in the coding program (that she needed to access to perform her job), she was subject to discipline and suspension,” according to the complaint.
Ms. Conrad was fired a short time after she was accused of violating HIPAA. She was a medical coder with Mosaic for 40 years before her termination, according to the report.
Ms. Conrad seeks more than $75,000 in compensatory damages, damages authorized by the False Claims Act, lost wages and benefits, attorneys’ fees and reinstatement.
Source: ASC COMMUNICATIONS 2018
Woman convicted for filing false medical claims, embezzling nearly $1 million from Detroit nonprofit
DETROIT – Lajuana Scott was sentenced Wednesday to one year in jail and five years on probation after she was convicted of three felony counts.
She was convicted of embezzlement from a nonprofit or charitable organization, health care fraud — false claim and Medicaid fraud – false claim. Court documents said the former clinic biller made Medicaid claims for services never performed and then used nonprofit money to gamble.
Scott was also ordered to pay $915,000 in restitution.
“Not only did this nonprofit employee steal nearly $1 million, but she stole from the taxpayers by falsely billing Medicaid and Medicare from a nonprofit tasked with helping those to fight drug addictions,” Michigan Attorney General Bill Schuette said. “I will continue to seek justice for the taxpayers of this great state by aggressively prosecuting individuals who steal from them.”
The Attorney General’s Health Care Fraud Division conducted an investigation into Scott’s activities as a biller at Nardin Park Recovery Center in Detroit. Nardin Park Recovery Center is a non-profit corporation and licensed methadone clinic.
Scott came to the attention of the HCFD through the use of “data mining” when a claims data query by the HCFD identified Nardin Park as a provider billing Medicaid and Medicare for suspicious claims.
The HCFD discovered Scott was billing multiple entities for the same psychotherapy services provided to Nardin Park patients, as well as billing on behalf of doctors who had not provided therapy to the patients.
The HCFD also claimed Scott was stealing money from the nonprofit’s bank account by withdrawing funds from an ATM at a Detroit casino and gambling with the money.
Source: WDIV ClickOnDetroit
Cambria County Plastic Surgeon Pleads Guilty to $288K in Medicaid and Insurance Fraud
Attorney General Josh Shapiro Announces Sentence against Doctor who Faked Billings for Higher Reimbursements
HARRISBURG – Attorney General Josh Shapiro announced that a Johnstown plastic surgeon who routinely billed Medicaid and private insurers for cancer treatments – even when the growths were not cancerous – pleaded guilty today to two felonies. The surgeon bilked private insurers and the Medicaid program out of $288,974 through this continuing scheme.
Dr. Daniel R. Nevarre, 58, pleaded guilty today to Medicaid fraud and insurance fraud, both third-degree felonies. He waived his preliminary hearing and was sentenced by President Judge Norman Krumenacker today in Cambria County to six to 23 months of house arrest, followed by three years of probation. Nevarre was the owner and operator of Plastic Surgical Associates of Johnstown, which he sold in May 2017.
“When people commit Medicaid fraud, they’re stealing tax dollars from people who are in real need of health care services,” Attorney General Josh Shapiro said. “Insurance fraud is also a serious crime that drives up premiums for everyday Pennsylvanians. This plastic surgeon gamed the system for his own profit – I won’t tolerate that, and we will hold him accountable.”
Starting in 2010, employees of Plastic Surgical Associates of Johnstown noticed Nevarre was billing all tissue samples as cancerous — even when subsequent laboratory reports indicated the tissues were non-cancerous. Nevarre also regularly up-coded routine procedures near the eye area as complex eyelid reconstructions — a surgery that requires at least a quarter of the eyelid to be reconstructed. Both of these fraudulent schemes resulted in higher reimbursements to Nevarre and his practice.
The defrauded insurance providers include Highmark Blue Cross/Blue Shield, UPMC, Medicare and the Pennsylvania Medical Assistance (Medicaid) program. Nevarre was ordered to pay full restitution to these providers as a condition of his sentence.
The case was prosecuted by Senior Deputy Attorney General Kara Cotter and Deputy Attorney General Edward Song.
Source: Office of Attorney General – Press Release
Data breach may have affected 500k+ patients, LifeBridge Health says
Baltimore, Md.-based LifeBridge Health notified more than 500,000 patients last week that their personal information may have been compromised during a privacy breach in September 2016.
The health system told Becker’s Hospital Review in an emailed statement May 23 that on March 18, officials discovered malware on the server that hosts electronic medical records data for the health system’s affiliated physician group and the shared registration and billing system for other LifeBridge providers.
Officials immediately investigated and found an unauthorized person had accessed LifeBridge’s server in September 2016. The health system told Becker’s it does not believe patient information was misused, but it notified more than 500,000 patients of the incident in a May 18 letter as a precaution.
“LifeBridge Health and LifeBridge Potomac Professionals [Potomac Physicians] take the protection of health information very seriously. While we have no reason to believe patient information has been misused in any way, out of an abundance of caution, we are notifying potentially affected patients as well as providing resources for those who have questions or concerns. We sincerely regret any inconvenience or concern that this situation may have caused,” the health system said in a prepared statement to Becker’s.
LifeBridge opened a call center to assist patients seeking additional information, officials said. For patients whose Social Security numbers may have been compromised, officials are offering one-year of complimentary credit card monitoring and identity protection services.
Source: Alyssa Rege @ Beckers Hospital Review