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Investigators and prosecutors continue to use their coding knowledge to wring big settlements from practices. These tactics have left four physician practices poorer by an average of $218,465, the U.S. Attorney’s Office for Maryland announced on March 16.

Question: How does the Supplemental Medical Review Contractor (SMRC) determine which reviews to perform? Does SMRC work for CMS or our Medicare administrative contractor (MAC)?
According the Department of Justice (DOJ), Jacksonville, Fla.-based First Coast Cardiovascular Institute (FCCI) has stumbled on a secret for nearly tripling the amount of money it owes to federal health care programs.

On the heels of two similar settlements, a Baltimore health system has settled a case for $122,928 in which it was accused of getting the doctors whose practice it had acquired to bill established patients as if they were new, inflating their charges.

Perhaps human evolution someday will allow us to provide care to the souls of the deceased, but until that time comes, CMS had better shore up its claims allowances.

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