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The Office of Inspector General (OIG) and 50 Medicaid fraud control units have been busy.


A new report for fiscal year 2011 list several cases in which the two entities worked together to apprehend health care fraudsters. Here are some examples from the Fiscal Year 2011 Medicaid Integrity Program Report:


  • Ronald Bailey, Ed.D., in Pennsylvania was sentenced to 18 months in prison and ordered to pay more than $164,000 after routinely overstating the time spent with behavioral services clients, forging patient signatures and submitting invoices that made it seem he was in two places at once.
  • Mark W. Izard M.D., P.C., in Connecticut had to pay $2.2 million to resolve False Claims Act allegations that he billed for services to patients in nursing homes when they were in hospitals, billed for attending physician services when the doctor’s presence was not required and billed for services performed by advanced-practice nurses or medical residents.
  • Muhammad Usman, owner of Royal Ambulance Service and First Choice EMS in Texas, was sentenced to 15 years in prison and ordered to pay $1.3 million after providing medically unnecessary rides for Medicare and Medicaid beneficiaries to and from dialysis treatments.


You can find the report at http://oig.hhs.gov/reports-and-publications/medicaid-integrity/2011/medicaid_integrity_reportFY11.htm#_Toc321220840


RAC Targets CT Scans


DCS Healthcare Services, the Region A recovery auditor (RAC), posted 10 issues about incorrect billing for CT scans for skilled nursing facilities, physicians, inpatient hospital Part B, outpatient hospital and critical access hospitals. The issues, which focus on head and neck scans and trunk and extremity scans, target those providers in New York and/or Connecticut.




About the Author


Karen Long is the compliance product manager for DecisionHealth and oversees products that relate to fraud and abuse and HIPAA compliance for physician offices and home health agencies, and accreditation compliance for hospitals. In her almost four years at DecisionHealth, Karen also has been the compliance editor and a reporter for Home Health Line, nation’s leading independent authority on home healthcare business, regulation and reimbursement.


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