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Health System paid $14.7 million to settle healthcare fraud allegations

Did you know billions of taxpayer dollars are spent funding false Medicare claims each year? Audit vendors and the DOJ use data analysis from claims submission to target medical practices and providers involved in the submission of upcoded medicare claims.  Are you and your staff aware of how to identify and correct billing errors before becoming a target? MyMeducator.com provides both the fraud, waste, and abuse training, and external chart audits, to help you identify overutilization and documentation issues.

July 19, 2018 – A New York-based health system will pay the federal government $14.7 million to settle healthcare fraud allegations that claim the system engaged in evaluation and management (E&M) upcoding.

According to the Department of Justice (DoJ), Health Quest Systems, Inc. and some of its subsidiaries allegedly submitted claims for E&M service levels that were not supported in the medical record. The health system billed the E&M services two levels higher than what the medical record indicated.

“This resolution is a testament to our deep commitment to protecting the integrity of federally- funded healthcare programs,” stated Acting Assistant Attorney General for the Justice Department’s Civil Division Chad A. Readler.  “We are determined to hold accountable healthcare providers that knowingly claim taxpayer funds to which they are not entitled.”

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