Due to increasing Medicare, Medicaid, and commercial insurance audits and other investigations and the rising number of qui tam actions (also known as whistleblower lawsuits), some physicians have hired attorneys and law firms to serve as their billing specialists. The case can be made for hiring an attorney to serve as the billing specialist in light of the potential penalties, sanctions, and possible exclusion from the Medicare Program if federal fraud and abuse regulations (including but not limited to the Anti-Kickback Statute, Stark Law, Anti-Markup Rule, and...
As part of a civil lawsuit alleging wage discrimination, a long-time Horizon Blue Cross Blue Shield executive who left the company last year alleges the insurance giant "knowingly and systematically" underpaid claims.
Kim Dans, 50, of Farmingdale, alleges the company "turned a blind eye" to the practice because it knew few members would contest the underpayments.
Dans worked for the company for more than two decades rising through the ranks until a pay dispute and concerns about accounting problems put her at odds with her supervisor, according to the lawsuit.