A recent Becker’s Hospital Review article stated that Catholic Health had agreed to pay $6M to settle overbilling allegations. A nursing home subsidiary of the health system allegedly submitted claims to Medicare for the highest and most expensive levels of therapy when that type of therapy was not medically necessary or was unsupported by medical records. The allegations against Catholic Health were originally brought by a whistle-blower under the qui tam provision of the False Claims Act.
In a statement to The Buffalo News, Catholic Health said the government's case against the system was based on a small sample of claims. The system admitted no liability or wrongdoing in the settlement. In addition to the monetary settlement, Catholic Health agreed to enter into a five-year corporate integrity agreement with HHS' Office of Inspector General.
This case dramatically points out the fact that comprehensive accuracy reviews of coding-related practices are a must! These reviews can ensure that a health system or hospital is maximizing revenue efficiency, while identifying potential coding compliance risks, and stopping coding-related denials.
An experienced partner in coding accuracy reviews can help health providers find problems before they become legal challenges. It’s just human nature -- people make mistakes that can impede your cash flow and even cause significant legal problems.
Aviacode offers a comprehensive accuracy review of any healthcare provider’s current coding processes, which will identify mistakes, help prevent future coding-related denials, and help minimize any governmental legal challenges. Our experienced and credentialed auditors are compliant with the latest coding guidelines and changes to ensure that audits are accurate, consistent, and comprehensive. Audits are completed and reports returned typically within three weeks. In addition, we can provide provider and staff education tailored to meet your needs as desired.
Aviacode auditors utilize the ProAuditor software, Aviacode’s proprietary application developed to streamline and standardize audits, and provide audit results that are actionable and easy to understand. ProAuditor, along with our expert auditors, provide a powerful combination to help identify corrective actions, and provide support and training to make them happen.
We offer chart audits from smaller physician groups to multi-site hospital systems. With this kind of accuracy review support, no one could claim a provider was intentionally trying to submit false claims.