From Jacksonville Business Journal: Claims against Jacksonville-based Healogics run deep and wide, with more than 600 clinics in 29 states named in federal fraud allegations brought by former employees of the wound care company.
The most recent lawsuit, which was filed in 2014 but unsealed in a Florida federal district court last week, details how two technicians employed by wound care centers operated by Healogics were pressured by the company to perform unnecessary procedures, procedures that were then billed to Medicare, Medicaid and Tricare, among others.
Jacksonville Business Journal Article
504 hospitals hit with whistle-blower lawsuit alleging false claims violations
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Jacksonville-based Healogics, which runs wound care centers across the U.S., has been accused of performing unnecessary hyperbaric oxygen therapy on patients in an apparent scheme to defraud Medicare, former employees said in a False Claims Act suit unsealed Wednesday in a federal court.
Willie and Michelle Arnold, a former hyperbaric technologist and a former hyperbaric safety director at Healogics respectively, allege that more than half the hyperbaric treatments the company billed to Medicare were fraudulent, according to the qui tam suit, which was first filed in July 2014.
-By Roque Wicker
CMS has just announced that starting March 2015 three states (Illinois, Michigan, and New Jersey) will be required to get “Pre-authorizations” for the next three years for non-emergent hyperbaric treatments for the following indications:
1. Chronic refractory osteomyelitis
2. Diabetic lower extremity wounds (Wagner 3 and above).
4. Preparation and preservation of compromised skin grafts and flaps.
5. Soft tissue radionecrosis.
The decision was made due to “high incidences of improper payments for these services”.
Authorization times will vary from 10-20 business days and as little as 2 days for “imminent” treatment for a life or limb threatening indication.
According to the memo A provisional affirmative prior authorization decision, justified by the beneficiary’s condition, may affirm up to 36 treatments in a 12-month period.
To read more about this please click the links below:
Insurance news HBO article
CMS prior auth process
CMS prior auth (PA) HBO presntation
Glad to see a new Hyperbaric unit in Glendale Arizona. Welcome!
news clip here