Part B News | Editors' Blog

Medical billing manager indicted in multi-million-dollar Medicare fraud ring charges

by: Roy Edroso Dec 17, 2015

A North Carolina medical billing manager appears to have been caught up in a Medicaid fraud ring and faces 10 years in prison.

Can you beat a whistleblower to the punch?

by: Roy Edroso Nov 23, 2015

If you're worried that a whistleblower is planning to bring a case against your practice, you may be able to pre-empt him by acting first -- but it's not a sure thing, says an expert.

Gym owner's $57K health care fraud charged dead people for workouts

by: Roy Edroso Nov 17, 2015

You don't have to be a doctor or even in the health care business to commit health care fraud. A judge court just sentenced an Orchard Park, N.Y., gym owner to three years probation and 100 hours of community service for defrauding private insurers for fake fitness sessions -- including a couple allegedly attended by dead people.

4 new physician targets in 2016 OIG Work Plan

by: Part B News staff Nov 2, 2015

Ensure your claims for prolonged services are documented and justified because the HHS Office of Inspector General (OIG) will focus on that area, according to one new issue in its 2016 Work Plan.

New Medicaid RACs will begin audits in 2012

by: Grant Huang Sep 16, 2011

You can add new, state-level recovery audit contractors (RACs) to your list of worries starting in 2012. All states are required to implement Medicaid RACs by Jan. 1 or lose out on federal funding, according to a CMS final rule posted Sept. 14. The new state-level RACs will be paid by states, operating under the same “contingency fee” model that the federal RACs use – i.e. they are paid based on cash recovered from you and your peers.

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