This is Fraud….

This is why it is essential to have competent qualified workers, from coders to billers, in the healthcare setting.  Aside from outright fraud, oftentimes there is simply a lack of knowledge and proper procedures which allow for errors and omissions as well as abuse and fraud.  Ultimately, it is the doctor and/or managers who face the consequences so competent qualified workers are the safety net that ensures proper reimbursement as well as administrative procedures are done.

Feds Announce Largest Ever Criminal Medical Fraud Takedown

Attorney General Loretta E. Lynch and the Department of Health and Human Services (HHS) Secretary Sylvia Matthew Burwell announced yesterday the largest ever healthcare fraud takedown.

The government claimed that those involved billed Medicare and Medicaid for medically unnecessary treatments, or treatments never provided. A total of 243 individuals were charged including 46 doctors, nurses and other licensed medical professionals for a total of $712 million in fraudulent billing.

Over 44 of the defendants were charged with fraud related to the Medicare prescription drug benefit program, also known as Part D.

About Definity Healthcare Administrative Services

My knowledge and experience includes working in the healthcare and computer fields for many years and my educational background includes a Ph.D. in Higher Education, Master’s in Public Administration, Bachelors in Psychology, over 80 credit hours from Pima Community college in healthcare administration and computer technology and another 30 credits from Tacoma Community College where I earned my Associates in Health Information Management and my RHIT certification. All of this education and experience has enabled me to earn four national certifications (CCS and CCS-P from AHIMA and CPC-H and CPC from AAPC) and to write two medical coding books for Cengage/Delmar Publishers. I have worked for more than 25 years with all types of schools, businesses, and agencies and have learned well what creates and what destroys quality. I have used my vast knowledge and education to problem solve including creating tremendous successes out of long-term failures. While others may strive to make lemonade out of lemons, at Definity Healthcareour standards of quality are higher as we make the finest lemon meringue pies instead!
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