%name | Medicaid Fraud | STATMedCare Payor and Physician Enrollment and Credentialing

Medicaid Fraud

So in case you missed it last month, Agency for Healthcare Administration (AHCA) announced the selection of of Chris M. Presley, a Law Enforcement Investigator in the Office of the Attorney General, as the winner of the 2017 Fraud Fighter Achievement Award.  Mr. Presley was the one responsible of discovering Medicaid Fraud that has taken place for some time now.  

Mr. Presley uncovered an orchestrated Medicaid fraud scheme that billed the Agency nearly $300,000 for services never rendered. The investigation resulted in the prosecution of Gregory Campbell and his co-defendants, resulting in an order of $460,000 in restitution and a 30-month prison sentence.  

trophy | Medicaid Fraud | STATMedCare Payor and Physician Enrollment and CredentialingThe Agency’s Office of Medicaid Program Integrity (MPI) initially discovered an overpayment that was under $6,000 to a provider who insisted his business had been closed for years. The case was referred to the Attorney General’s Medicaid Fraud Control Unit (MFCU), and during the course of his investigation Mr. Presley discovered that an identity theft had occurred, allowing Mr. Campbell to bill the Agency under a false name. Mr. Presley was able to confirm the identity theft with the IRS, leading to the charges levied against Mr. Campbell and his co-conspirators.

Feel free to read the entire announcement at AHCA.

Medical billing can be challenging, and the slightest error can be mistaken for fraud.  That is why you need medical billing staff or a professional medical billing company that are well skilled and educated in your speciality and also remain diligent in staying current with all of the new Medicare or Medicaid billing and coding rules.  

You also need to ensure that you and your providers are credentialed properly with Medicare, Medicaid and commercial payers and that is where STAT MedCare Solutions comes in; STAT MedCare will ensure mistakes are eliminated.  Credentialing mistakes can cause claims to be denied, which will cost your practice time and money.  If you need help with your credentialing, please don’t hesitate and contact us. Also, STAT MedCare wants to thank Mr. Presley on his efforts of maintaining the integrity in our industry, and congratulations on his achievement.

Let us share one of our professional tools with your practice as well, so you can compare it to or add to your current credentialing process:  Here is a free copy of our Provider Enrollment Checklist.  

Since 2003, STAT MedCare Solutions has been an expert in Provider Enrollment, Licensing, Rate Negotiation, and other Credentialing-related services.  STAT’s mission is, “Providing Client Services on a foundation of Trust and Integrity.”  We stay on top of teaching, training, and equipping to properly manage the workplace as an industry expert.  STAT has submitted/renewed 250,000+ licenses, submitted more than 10,000 appeals, and renegotiated more than 3,000 contracts. STAT services practices and organizations who are start-ups, surviving, experiencing (rapid) growth,  or maturing Enterprise clients. Contact our Sales team for a free consultation at 877-887-1784, Ext. 505

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