Category Archives: Uncategorized
Michigan Doctor Sentenced to 4 Years in $6.3M Medicare Fraud Case
Dr. Sophie Toya, 56, of Bloomfield Hills, Michigan, was sentenced to four years in prison [...]
Jul
Medical Coder Indicted in Wrongful Coding – Found Not Guilty
Kenia Valle Boza, a certified coder who worked at Pasteur Medical Center and later HealthSun [...]
Jul
Denial$ to Dollars: Virtual Appeal-Writing Workshop
Thursday, April 10th | 12 PM – 2 PM ET $199/attendee Do you have a [...]
Feb
Surprise Billing Handbook: A Guide for Lawyers and Providers
Check out the latest project from Joe Rivet! Both e-books and physical copies are available. [...]
Feb
Blue Cross Blue Shield of Michigan will Charge for Appealed Denied Claims
Effective March 1, 2025, BCBSM will begin enforcing a long-standing policy against hospitals that repeatedly [...]
Feb
States are Looking to Sanction Payers for Denials
States are closely scrutinizing payers who are frequently denying treatments. The California senate has recently [...]
Feb
$100,000 Penalty Against Mental Health Center – Failure to Provide Timely Access to Records
The Office of Civil Rights (OCR) imposed a $100,000 penalty against a California mental health facility, Rio Hondo [...]
Jan
Virginia Practice Pays $2M For False Documentation
A hospital in Virginia agreed to pay $2,378,731.06 for submitting claims to Medicaid that were improperly modified by the request of the practice’s employee. Here [...]
Jan
Verification of Benefits – Are Payers Bound by Those Calls?
Verification of Benefits (“VOB”) occurs nearly daily, and the practice relies on the information provided by the [...]
Jan
G2211 Can be Reported with Preventive Services
CMS Issued Transmittal 13015 on December 23, 2024, covering expanded reporting of G2211. CMS allows payment for G2211 when certain [...]
Jan