The gravy train stopped for a Flowood healthcare company after Medicare caught it billing over and over for services provided to who else but dead people.
The Centers for Medicare and Medicaid Services suspended payments to Wound Care Management Specialists in April after finding the company defrauded Medicare. How bad was the fraud? Read on:
Data analysis revealed that Wound Management Specialists LLC improperly billed Medicare for services provided to 53 beneficiaries after their reported date of death, 11 of which had multiple dates of service after their reported date of death.
Data analysis revealed that Wound Management Specialists LLC has a pattern or practice of submitting claims that fail to meet Medicare requirements. Specifically, Wound Management Specialists LLC has history of non-compliant billing for skin substitute services which found services to be not reasonable and/or necessaiy which has resulted in the issuance of eight overpayments on six prior occasions... This continued non-compliance indicates a systemic failure to implement conective actions and adhere to Medicare billing requirements.
CMS directed Wound Management to return the overpayments within 60 days. The company appealed the decision.
Wound Management filed a Chapter 11 bankruptcy petition in August. The petition states the company owes $42.7 million to Medicare.
Medicare cracked down on payments skin substitute products last year after healthcare providers exploited a loophole to the tune of billions of dollars. Spending on such product skyrocketed 640% from just over $390 million per quarter to $3 billion per quarter in just two years, thus raising quite a few red flags. CMS got to work as it started auditing and prosecuting. Earlier post.
The party came soon to an end for such companies. Wound Management's financial statements reflected the new Medicare handcuffs:
Revenue fell 80% in one year. Hence, bankruptcy. Earlier post.
Kingfish note: The bankruptcy petition also states Wound Management owes $78 million to Advanced Healthcare Solutions. Wound Management and Advanced Healthcare Solutions have the same Flowood address: 778 Liberty Road.
Sources have also said Medicaid covered treatments such as those offered by Wound Management. However, the State Auditor can not investigate such claims as those are handled by a specific unit at the Attorney General's office.
43 comments:
And the crazy libs want universal run government healthcare. Can you imagine the fraud if all the providers got paid from the government
Has anyone gone to prison?
If this falls within the jurisdiction of a special unit of the Attorney General's office, then where are they?
@11:04 - we have a Republican senator, Rick Scott in Florida who oversaw a company that had to pay $1.7 billion in fines for medicare fraud and was found guilty of 14 felonies. It’s obvious why Republicans don’t want universal healthcare, they’d lose billions in revenue from their schemes being put to an end.
Who are the physicians involved in these businesses located in Flowood, MS?
Somebody got rich, and some politician got elected with the proceeds. That's Mississippi in a nutshell. See the Bridges case for another example. No one is actually at the helm of the sinking U.S. Mississippi.
I doubt the physicians will be the culprit. This is an internal billing issue and the company was most likely using the physicians' credentials to file fraudulent claims. All leadership within the company should be questioned. Who is filing the claims? Who is reconciling the books? Who is overseeing the daily operations? Should be an easy case to crack.
Hell, I would have faked a wound to be cut in on this deal.
Ooops.
Who are the members of these LLCs?
Someone needs to check PACER.
Name names, please.
Which Mississippi politician got elected as a result of the Bridges' nutshells? Be specific.
Is this the local branch of a Minn. scammer?
Scott is a RINO.
11:10 asks,"If this falls within the jurisdiction of a special unit of the Attorney General's office, then where are they?" Two words: Lynn Fitch.
At what point do you decide to start using dead people as patients? 53 of them and that's just what they've found so far. Wow.
And the two companies that just happen to have the same address, one saying it owes the other $78 million? Well thats a big old red flag. Hope Medicaid has started pulling records from both companies.
Kingfish, website below says they have 18 locations in 11 states. Wonder if the other locations are being investigated?
https://ourhealthnetwork.com/group-practice/wound-management-specialists-llc-flowood-ms-5193056364
They will have to repent for their sins and pray for mercy. I can't imagine the greed they felt and still continued
Round up the usual suspects https://www.youtube.com/watch?v=vtSmfws0_To
@12:06pm. As is usual in Mississippi, no one will ever know. Money is pretty easy to hide when it comes to campaign contributions, and especially when the Attorney General isn't interested in actually uncovering the corruption that likely benefitted their (her) party.
If Republicans hadn't cut oversight staffing to the bone there'd be people doing oversight on all this fraud.
Not under the Trump Administration.
Another DNC funding source.
Here is a link to the current company operating at the same address with the same leadership as Wound Management - https://strategicsolutionsco.com/about/
Wound Management Specialists LLC is a large multi-specialty medical practice based in Jackson, MS, with 166 affiliated healthcare providers practicing across 18 locations in 11 states.
The practice brings together providers across multiple specialties, including nurse practitioner, physician assistant, general surgery, and family practice. Its providers are in-network with 17 insurance plans, though coverage varies by individual provider and should be confirmed before scheduling.
Across its providers, the practice has a reported average Merit-based Incentive Payment System (MIPS) score of 20.0 out of 100, a quality measure published by the Centers for Medicare & Medicaid Services.
Minnesota can't have all of the fun.
It's not a loop hole if it's written into the law
@12:48, LOL, seriously, good luck surviving the upheaval, LOL LOL.
Medicare is targeting wound care providers all over the country with wild accusations based on "data analysis" that it refuses to explain or support. Just because Medicare says something doesn't mean it's true. No one billed services to dead people. That's just ridiculous.
medicare audits are notoriously unreliable. it sounds like bullshit to suspend someone's account based on allegations and without due process. typical government work
It's true that Medicare is going after all types of wound care providers. Central Surgical Associates has a pending lawsuit against Medicare for exactly this.
After a RAC audit, the government intercepts 100% of all future Medicare payments so the debtor entity now has zero cash flow and is out of business.
The narrative about this is incorrect and unfair. Medicare's data had wrong dates of service, wrong dates of birth, same name / different patient errors, and other flaws. Those claims had nothing to do with skin substitutes. All of that was shown to Medicare with company documentation but it still enforced the suspension, never issued a retraction, and never acknowledged its mistakes.
This is Medicare's way of enforcing an unlawful policy decision to wipe out the skin substitute industry as a whole. That letter is an exhibit to a class action lawsuit filed against Medicare for its unlawful practices to the industry.
Suing the Feds ain't gonna work.
Not unreliable in this case. This is just the tip of the iceberg concerning WMS. There will be jail time. People who work in the wound care industry in the Southeast have been waiting for this day. Not just MS but LA, AR, AL, TX, TN, FL etc.. Everyone knew it was just a matter of time before it all caught up to them. WMS has the worst reputation in the wound care world.
do you understand that medicaid and medicare are government run insurance on a smaller scale. The government allows the fraud because they don't check. Private insurance companies make sure bogus claims are not submitted. Why do you think it's so hard to have stuff done with private insurance. They are making sure they don't pay for stuff that is not needed. duh
Crazy that the same people being charged with fraud have now opened up a consulting practice! Why would anyone hire them?!?
One of my physicians bills Medicare $352 for a semi-regular procedure I must receive, but will accept $71 total if I pay the bill out of my own pocket. The system is totally screwed up.
@3.30 PM
Good, bad or indifferent, that is how the healthcare business works in the US. Physicians, hospitals, etc. can bill whatever number they want to Medicare, Medicaid or commercial insurance, but they will only be paid the published Medicare/Medicaid rate or the contracted rate they have with the commercial insurers. The difference is written off as a “contractual discount.”
For your physician, there is probably a commercial insurance payer who pays something close to $350 for whatever procedure you had done. Your physician has to bill at least that amount or more, or the insurance company would pay the lesser of the two. Medicare’s published rate is $71, so your physician either has to take that amount or just not perform that procedure on Medicare patients. Most physicians will take Medicare rates because Medicare patients (older and sicker) make up a significant part of their patient panel.
Free tip: Many physicians (like the one you mentioned) will take Medicare rates if you pay up front out of your pocket because they are getting paid that same amount from many of their patients anyway, and they have to go through the whole billing song-and-dance to get those dollars, which takes time (measured in weeks or months) and effort . If you whip out a credit card and pay the same amount on the spot, they are better off. Medicare rates are publicly available – check with your favorite AI LLM on where you can find those. For example: Medicare pays physicians between $88 and $125 for typical office visit (that is for the visit only, which wouldn’t include labs or procedures).
Not approving your comment because although it was good, the name of the creditor was wrong. ;-)
12:49, because of all the prison sentences under Biden, right?
https://x.com/kanekoathegreat/status/2105375659401035868?s=46
Will anyone go to jail? We bash gang-bangers and thugs all the time, but these people are no different. The pen is mightier than the sword...
It’s amazing after seeing all the large scale fraud involved in the greedy medical system that you think your precious little primary care doctor/pediatrician have your best interests at heart rather than their pocketbooks.
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