US: Medicare fraud cases settled for $7.1M after knee braces, injections deemed unnecessary - - PressFrom - US
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US Medicare fraud cases settled for $7.1M after knee braces, injections deemed unnecessary

12:41  20 october  2019
12:41  20 october  2019 Source:   foxnews.com

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Medicare for medically unnecessary viscosupplementation and braces . Contemporaneous with the civil settlement , the settling ORI clinics and related parties entered into a Corporate Integrity Agreement (CIA) with the Department of Health and Human Services Office of Inspector General.

Which Knee Braces are Covered by Medicare ? How Much Will I Have to Pay for a Knee Brace ? However, acquiring and using a knee brace is In order have a brace covered by Medicare , it must be deemed medically necessary that you need one, which means you need it to help treat or manage

Seven former Osteo Relief Institute clinics accused of billing Medicare for unnecessary knee braces and injections to treat osteoarthritis have agreed to pay more than $7.1 million in a settlement, the U.S. Justice Department announced Friday.

Medical equipment is pictured on the wall of an examination room inside a Kaiser Permanente health clinic located inside a Target retail department store in San Diego, California November 17, 2014.© Mike Blake/Reuters Medical equipment is pictured on the wall of an examination room inside a Kaiser Permanente health clinic located inside a Target retail department store in San Diego, California November 17, 2014.

“Billing Medicare for medically unnecessary items and procedures puts patients at risk and wastes taxpayer funds,” Assistant Attorney General Jody Hunt of the Civil Division said in a statement. “Today’s settlement demonstrates that the Department of Justice will pursue companies and individuals who seek to benefit at the expense of federal health care programs and their beneficiaries.”

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Medicare Part B covers knee braces when medically necessary as it is considered to be durable medical equipment. Durable medical equipment can withstand repeated use and has an expected lifetime of at least three years. To be covered, the knee brace must first be deemed medically

Quorum settles fraud cases for .5 million | Single Article. In an agreement that will settle false claims allegations, medical equipment and supply company American HomePatient Inc. (AHOM) and its HomePatient Delaware affiliate have agreed to pay the federal government $ 7 million.

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The settlement concludes a probe of clinics in six states that performed administered viscosupplementation injections -- where doctors inject a gel-like substance into a patient's knee joint to prevent symptoms associated with arthritis -- to patients who did not need them and filed false claims to Medicare for the treatments. The government also said owners of these clinics used multiple brands of the injection successively on patients without clinical support and purchased reimported forms of the drug from foreign countries. In addition, the clinics provided patients with unnecessary custom knee braces.

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The back brace or knee brace that was billed as “free” is not free at all. Later, Medicare will be billed. Just on back braces , taxpayers spent nearly 8 million between 2010 and 2016. How to mitigate Medicare fraud . Only answer the phone if it’s a caller that you know.

Unnecessary health care (overutilization, overuse, or overtreatment) is health care provided with a higher volume or cost than is appropriate.

The investigation originated in Lexington, Ky., after a whistleblower filed a lawsuit prompting a review of Medicare claims data.

The whistleblower is set to receive $857,550 from the government.

Six ORI clinics -- in Phoenix; San Diego; Lexington, Ky.; Wall Township, N.J.; Dallas and San Antonio -- will collectively pay the government $6 million. A seventh clinic, in Colorado Springs, Colo., will pay approximately $1.13 million.

“This settlement demonstrates that the U.S. Attorney’s Office will continue to identify and hold accountable those healthcare providers who improperly bill medically unnecessary services,” Robert Duncan Jr., U.S. Attorney for the Eastern District of Kentucky said in a statement. “It is also an example of our commitment to identify those who seek to defraud the government, as well as to work with whistleblowers, who play a critical role in helping keep entities honest, and are encouraged to report suspected waste, fraud, and abuse by those billing federal programs.”

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As part of the settlement, the clinics also agreed to implement new compliance controls and will be subjected to annual ORI clinics claims reviews by an independent review organization.

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