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A downstate New York ophthalmologist stands accused of misrepresenting simple eyelid procedures as much more complicated surgeries and billing millions more than he should have for them.

 
As part of an effort entitled the Regulatory Sprint to Coordinated Care, CMS and OIG released advance copies of proposed regulatory changes on Oct. 9. The proposed rules would modify regulations that have presented obstacles to physicians, hospitals and other providers as they transition away from traditional fee-for-service (FFS) payment models toward value-based arrangements.
 

Benjamin David Danneman, 37, of Eureka, Mo., was employed by at least three local health care organizations that should be conferring with lawyers now. On June 12, Danneman was sentenced to 57 months in prison for working for them as a nurse and, in one case, as an assistant director of nursing without a nursing license.

A practice that follows the rules for incident-to billing can expect 100% of reimbursement for a non-physician practitioner’s (NPP) services reported under a physician’s provider number, rather than 85% billed under the NPP’s ID. A practice that breaks the rules for incident-to billing can expect trouble.
In case you were thinking federal investigators would never be interested in your therapy claims, here are three practices from today's HHS OIG website that would likely disagree.

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