"8 anesthesiology groups in Colorado hit in Medicaid fraud probe"

[Carbocation1]

http://www.bizjournals.com/denver/n...npCoSO1qd+FguvKNdYeb8&t=1458681141&j=71653132

http://www.denverpost.com/news/ci_29670612/3m-fraudulent-medicaid-billings-recovered-by-colorado-ag

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[Carbocation1]

The largest over-payments involved Banner Greeley Anesthesia, which has returned $2.1 million to the state. Other groups named in the probe and ordered to return payments were:

• Catholic Health Initiatives, $412,725.
• Longmont Anesthesia, $155,014.
• Kaiser Health Plan Colorado, $115,014.
• Eastern Plains(Colorado) Anesthesia, $85,926.
• Colorado Anesthesia Group, LLC, $68,635.
• Alta Anesthesia PC, $29,100.
• Glenwood Springs Anesthesiology LLC: $16,006.

 

[Impromptu]

Had Medicaid been paying at market rates, they would have had a much bigger headline of $15 Million being returned.

 

[caligas]

Had Medicaid been paying at market rates, they would have had a much bigger headline of $15 Million being returned.

What exactly were they doing wrong?

 

[deltamed]

What exactly were they doing wrong?

I'm guessing based on the lack of charges or sanctions it was more "i didn't know I was supposed to check that box or use that code in XYZ situation" rather than intentional fraud. Not to say medicaid shouldn't recover that money, but coding/billing in medicine has become so complex that they now need a whole new army of personnel to monitor dotting the i's and crossing the t's.


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