January 22, 2013

Region D RAC hits $1 Billion in Corrections

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HealthDataInsights, the recovery auditor (RAC) for Region D, has made $1 billion in corrections since the 2009 start of the national program, according to a Jan. 7 press release.

That accounts for 36 percent of all corrections to date, the release states.

HDI includes 17 states and three territories – Alaska, Arizona, California, Hawaii, Iowa, Idaho, Kansas, Missouri, Montana, North Dakota, Nebraska, Nevada, Oregon, South Dakota, Utah, Washington, Wyoming, Guam, American Samoa and Northern Marianas.

In Region B, CGI Federal posted two updates to its website:

  • The Rituximab issue for professional services has been put on hold for WPS claims. CGI is processing cancellations for claims that were incorrectly adjusted and will send a rescind letter to notify affected providers.
  • For the CAH/PAT adjustment, CGI has submitted cancellation requests to reverse the AR for claims that should have been excluded from the 72-hour rule. CGI modified the edit to make sure it doesn’t affect claims in the future.

Fraud news

  • Pediatrician charged in connection with $900,000 Medicaid fraud. A pediatrician who billed Medicaid for wound repairs more frequently than any other provider in New Jersey from January 2004 through December 2008 was charged with health care fraud, according to the U.S. Attorney’s Office in New Jersey. The claims accounted for 99.4% of all claims in New Jersey for suturing or stapling of facial wounds larger than 30 centimeters. And virtually all of the claims Badawy Badawy, M.D., submitted for supposed wound repairs on children were fraudulent, the U.S. Attorney’s Office states. Badawy faces up to 10 years in prison and a maximum fine of $250,000 or twice the gross gain or loss from the crime.

Maryland man sentenced to 19 months prison in connection with $600,000 of false health care claims. Uche Ben Odunzeh of Laurel agreed to pay more than $277,000 in restitution to the District of Columbia after pleading guilty in October 2012 to one count of conspiracy to commit health care fraud, according to the U.S. Attorney’s Office in the District of Columbia. Odunzeh owned durable medical equipment company Emerald Medical Services and from January 2008 to March 2011, the company submitted 100 claims to the District of Columbia Medicaid program for power wheelchairs. He billed for the most expensive power wheelchairs while providing more basic models.

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About the Author

Karen Long is the editor of Physician Solutions 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.

Contact the Author

KLong@decisionhealth.com

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