Of the 242 unique enrollee-years that were audited, 98 had validated medical records that supported the HCC (Hierarchical Condition Categories) diagnoses submitted. The other 144 unique enrollee-years diagnoses were not supported by the medical records, because Peoples Health was not able to locate the medical records.
Category: COMPLIANCE
Salisbury Medical Practice Pays the United States Over $286,000 to Resolve Claims that it Billed for Medical Services Not Provided
Peninsula Internal Medicine, L.L.C., a medical practice located in Salisbury, Maryland, and the Estate of Candy Burns have paid the United States $286,631.33 to settle allegations that Peninsula Internal Medicine (“PIM”) and its former owner, Candy Burns, submitted false claims to the United States for medical services that were not provided.
Windham Eye Care Practice and its Owners Pay $192K for Employing “Excluded” Individual
Leonard C Boyle, United States Attorney for the District of Connecticut, today announced that WINDHAM EYE GROUP, P.C., an ophthalmological medical practice located in Windham, and its owners, DANA WOODS, M.D. and WILLIAM KAUFOLD, M.D., have entered into a civil settlement agreement with the federal and state governments to resolve allegations that they improperly employed an individual who was excluded from all federal healthcare programs.