From Report on Medicare Compliance - Sutter Health in California has agreed to pay $46 million to settle allegations that it overcharged for anesthesia in a case that breaks new ground in more ways than one. It was brought by the state Department of Insurance but originated with a whistleblower under the California Insurance Fraud Prevention Act (IFPA). The lawsuit alleged that Sutter Health, which includes 20 hospitals, improperly billed private insurers for anesthesia under revenue code 37x. Read more
From Report on Medicare Compliance - Certain executives at Johnson & Johnson and its pharmaceutical affiliates will soon lose their bonuses if they engage in “significant misconduct” related to manufacturing, sales or marketing, according to its new corporate integrity agreement. The five-year CIA is part of J&J’s $2.2 billion settlement of criminal and civil allegations related to its prescription drugs Risperdal, Invega and Natrecor, the Department of Justice said Nov. 4. The settlement originated with whistleblower lawsuits… Read more
From Report on Medicare Compliance - If he could wager on which diagnoses trip up hospitals, Jon Elion, M.D., would bet the house on encephalopathy, malignant hypertension and sepsis. “If I were a compliance officer, my first day on the job I would be worried about sepsis, encephalopathy and malignant hypertension,” says Elion, associate professor of medicine at Brown University and CEO of ChartWise Medical Systems. These diagnoses tend to pay well as MS-DRGs or to increase MS-DRG… Read more
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