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HIPPA
Fraud & Abuse Compliance Plans
Professional Courtesy Discounts Fraud
Texas Prompt Payment/Clean Claim Laws
Texas Insurance Code
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59 Fed. Reg. 65,372, 65,374 et seq. (Dec. 19, 1995)
"A provider, practitioner, or supplier who routinely waives Medicare co-payments or deductibles is misstating its actual charge. For example, if a supplier claims that its charge for a piece of equipment is $100, but routinely waives the co-payment, the actual charge is $80. Medicare should be paying 80 percent of $80 (or $64), rather than 80 percent of $100 (or $80). As a result of the supplier's misrepresentation, the Medicare program is paying $16 more than it should for this item." |
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