Comprehensive Psychiatric Services in California has agreed to a $2.75 million settlement to resolve allegations that it violated the False Claims Act. The company was accused of using improper add-on codes when billing psychotherapy services to government health care programs.

Thomasina Amponsah of Baltimore County, Md., has pleaded guilty to aggravated identity theft and making false statements related to health care. Authorities say that Amponsah, who has never had a nursing license, used stolen nursing credentials to work as a nurse at more than 40 facilities, including nursing homes and a public school.

Teresa D'Unicorn, a primary care assistant in Palmer, Alaska, has pleaded guilty to attempted medical assistance fraud. D'Unicorn admitted to billing Medicaid for services that weren't provided between 2019 and 2021, according to prosecutors. She has been ordered to pay $30,000 in restitution, will serve three years of informal probation and has been excluded from participating in Medicaid for five years.

Payer audit triggers have expanded beyond high-dollar claims to include clinical validation and high-risk diagnoses, and health information professionals are likely to play a bigger role in coding audits as technology and audit triggers evolve, writes registered health information administrator Angela Comfort. Discrepancies between EHR data and claims also lead to audits, as do inconsistent terminology and unspecified codes, especially in value-based care models.

Presbyterian Medical Group is using AI to improve clinical workflows and reduce clinician burnout, health system President Dr. Darren Shafer says. Presbyterian tests the solutions at central locations before deploying them to rural facilities. "Our goal is ultimately less pajama time. That's probably the No. 1 issue in primary care and also in ambulatory medicine," Shafer says. AI helps improve patient interactions by allowing clinicians to focus more on patients, according to Shafer.