A False Claims Act lawsuit has been filed by Integra Med Analytics against Providence St. Joseph Health, seeking $188.1 million related to alleged upcoding of Medicare claims.

According to media reports, Integra made the discovery of allegedly unwarranted major complication and comorbidity secondary codes. In its investigation, Integra identified J.A. Thomas and Associates (JATA) as the clinical documentation improvement consultancy for Providence. The lawsuit alleges Providence and JATA were "pushing doctors to make unwarranted diagnoses" and "using leading queries to change doctors' original diagnoses."

Reporting our lead story during this edition of Monitor Mondays will be False Claims Act attorney Mary Inman, partner in the London law office of Constantine Cannon. Also on board reporting the data analytics associated with this developing story will be senior healthcare analyst Frank Cohen, director of business intelligence and analytics for DoctorsManagement.

The broadcast rundown also will include:

• Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment.

• Monday Focus: Michael Salvatore, MD, FACP reports on the ancient practice of alchemy and how its modern-day equivalency is turning health into disease. Dr. Salvatore is the physician advisor and medical director of the palliative care team at Beebe Healthcare in Delaware.

• Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron continues his reporting on the perennial question, “should I refund an overpayment?” He will pose the question as a listener quiz.

• Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, reports on all the latest hot topics.

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