Here we go again and we are just going to see lifetimes of the money being shifted back and forth and back and forth again and again. When you
read this case this goes back to 2007 and the article states that the Mayo Clinic promptly paid the difference when it was brought to their attention. Everybody’s out to make a name for themselves at times instead of taking care of patients and this time it appears to be the DOJ/HHS and plus you had to get the whistleblowers paid. This was a bit complex with billing for pathology reports and the processes there of. Again what a waste of taxpayer money here as Mayo voluntarily refunded the money.
It’s incidents like this that take people away from chasing “real fraud” that lurks out there. On top of this Mayo has to also pay the legal fees for HHS in pursuing this case. I thought they were a little smarter over at HHS and were working on better efficiencies. The whistleblowers have to be paid $229,822 for their part of this. The news is just full today of money shifting with algorithms and with the complexities of healthcare billing 
these types of stories will go on and on and be enough of a disruption to keep many from seeing the “big picture”. This was classified as a “billing error” so was it the software…nothing in this article stated anything of such. Here’s one example below…we have software today that does a really good job with creating “desired” results but are the results accurate? Well I don’t think we would have about half of these issues if it was.
Bad Algorithms in Healthcare Payment Systems and Risk Assessments–Did the Hospital Bill Fraudulently or Were They Sold Formulas That Did Not Conform
We have the same nonsense going on with re-admissions even to the point to where former HHS director Levitt and the Heritage group put out a bounty of $3 million to solve this issue with an algorithm. Sorry folks the algo is not the only answer as this is still the “human” business and sure there may be some good findings here and there in the number crunching going on, but as far as having a realistic target, it’s bogus in focus, but naïve folks who have not written code or deal with data get sucked in all the time that “yes there can be this magical algorithm that will be the cure all”…think again…lol. This is why some government departments are in dire need of some new executives for sure, like HHS and the SEC. They are just so naïve.
Here’s a good video to watch that shows how naïve we can be and how the Dark Arts of Mathematical Deception Work. Thanks goodness there’s a few folks out there that get this.
The old figureheads in office are so far behind the times and all they do is make pubic statements anymore and some of those are questionable and when they get caught before discussing with the department experts and support folks, they end up with foot in mouth today. We need department heads that “get it” and don’t have to function this way and have some technology in their backgrounds and until then private enterprise and the banks just eat our lunch and get more of our money with “their algorithms”. The figureheads running government departments sit in denial that “those algorithms” exist and have teeth for the most part.
In summary, why was all this time wasted here with Mayo? It’s beyond me and again just makes the fact that we don’t have executives in charge with a bit of technical knowledge stick out like a sore thumb. Spend more money on finding these folks in the image below. BD
MINNEAPOLIS, MN – Earlier this month, the Mayo Clinic agreed to settle claims by the U.S. Department of Justice that the Rochester, Minn.-based healthcare system falsely billed Medicare and Medicaid for surgical pathology services that were not provided.
The settlement includes $263,000 that Mayo already voluntarily paid the government and an additional $1 million that still must be paid.
According to Minnesota’s U.S. Attorney’s office, the suit was originally brought in 2007 under the “whistleblower” provisions of the False Claims Act. This statute allows private individuals to file civil actions on behalf of the United States and share in any recoveries obtained as a result. In this case, the government will pay $229,822 to four involved whistleblowers.
“Upon discovering a billing error in 2007, Mayo promptly corrected it and voluntarily refunded $262,975 to the government. The error was identified and corrected long before Mayo became aware that a sealed complaint had been filed and before Mayo was notified that the DOJ was evaluating whether to become involved in the complaint,” according to a Mayo Clinic press release.
http://www.healthcarefinancenews.com/news/mayo-clinic-agrees-126m-settlement-over-false-billing-claims?topic=04,29
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