More Essential Data From CMS
Timothy Powell, CPA, CHCP
April 24, 2023
The Centers for Medicare & Medicaid Services (CMS) just keep putting out the data, and we want to keep you aware of both the data
The head of a group of Michigan- and Ohio-based pain clinics and other providers will also have to pay $51 million in restitution.
Federal officials have announced a 15-year prison term for the healthcare CEO who admitted to orchestrating a massive fraud scheme resulting in more than 6.6 million doses of medically unnecessary opioids.
Mashiyat Rashid, 40, of West Bloomfield, Mich., the former CEO of the Tri-County Wellness Group of pain clinics and medical providers in Michigan and Ohio, also developed and approved a corporate policy to administer painful, unnecessary back injections to patients in exchange for the unnecessary prescriptions, the U.S. Department of Justice (DOJ) announced in a press release. In addition to the prison sentence, Rashid was also ordered to pay more than $51 million in restitution to Medicare – as well as forfeiture of property traceable to proceeds of the scheme, including more than $11.5 million in cash, commercial real estate, residential real estate, and a Detroit Pistons season-ticket membership.
Rashid had pleaded guilty in 2018 to one count of conspiracy to commit healthcare fraud and wire fraud, and one count of money laundering. He was the second of 21 defendants, including 12 physicians, to be sentenced following convictions, including four physicians who were convicted after a one-month trial in 2020.
Federal officials described Rashid’s patients as some who were “suffering from legitimate pain, and others of whom were drug dealers or opioid addicts,” yet many who fit both descriptions were given prescriptions of Oxycodone 30 mg on the condition that they submit to unnecessary back injections.
“Testimony at the trial established that in some instances, the patients experienced more pain from the shots than from the pain they had purportedly come to have treated; that audible screams from patients were observed throughout the clinics; and that some patients developed adverse conditions, including open holes in their back,” the DOJ’s press release read. “Patients, including patients who were addicted to opioids, who told the doctors that they did not want, need, or benefit from the injections, were denied medication by the defendants and their co-conspirators until they agreed to submit to the expensive and unnecessary injections. The evidence further established that the defendants repeatedly performed these unnecessary injections on patients, as Tri-County was paid more for facet joint injections than any other medical clinic in the United States.”
Prosecutors said the Tri-County clinics intentionally targeted the Medicare program and recruited patients from facilities such as homeless shelters and soup kitchens. Evidence introduced at trial indicated that Rashid “only hired physicians who were willing to disregard patient care in the pursuit of money,” incentivizing them to follow the Tri-County protocol of offering opioid prescriptions and administering unnecessary injections by offering to split the Medicare reimbursements for the procedures.
A former Tri-County employee testified at the trial of Rashid’s co-defendants that the practices at the clinic were “barbaric.”
The joint investigation resulting in the charges and convictions was conducted by the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) and the Internal Revenue Service-Criminal Investigation (IRS-CI), with Assistant Chief Jacob Foster of the National Rapid Response Strike Force and Trial Attorney Tom Tynan of the DOJ Criminal Division’s Fraud Section prosecuting.
Since its inception in March 2007, federal officials noted, the Health Care Fraud Strike Force, which maintains 15 strike forces operating in 24 districts, has charged more than 4,200 defendants who have collectively billed the Medicare program for nearly $19 billion.
The Centers for Medicare & Medicaid Services (CMS) just keep putting out the data, and we want to keep you aware of both the data
Learn how providers can avoid falling into the trap of making clinically suspect diagnoses. The U.S. Department of Health and Human Services (HHS) Office of
Please log in to your account to comment on this article.
Stop revenue leakage and boost hospital performance by mastering risk adjustment and HCCs. This essential webcast with expert Cheryl Ericson, RN, MS, CCDS, CDIP, will reveal how inaccurate patient acuity documentation leads to lost reimbursements through penalties from poor quality scores. Learn the critical differences between HCCs and traditional CCs/MCCs, adapt your CDI workflows, and ensure accurate payments in Medicare Advantage and value-based care models. Perfect for HIM leaders, coders, and CDI professionals. Don’t miss this chance to protect your hospital’s revenue and reputation!
Struggling with ICD-10-CM coding for diabetes and complications? This expert-led webcast clarifies complex combination codes, documentation gaps, and sequencing rules to reduce denials and ensure compliance. Dr. Angela Comfort will provide actionable strategies to accurately link diabetes to complications, improve provider documentation, and optimize reimbursement—helping coders, CDI specialists, and HIM leaders minimize audit risks and strengthen revenue integrity. Don’t miss this chance to master diabetes coding with real-world case studies, key takeaways, and live Q&A!
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s fourth quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s third quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Struggling with CMS’s 3-Day Payment Window? Join compliance expert Michael G. Calahan, PA, MBA, CCO, to master billing restrictions for pre-admission and inter-facility services. Learn how to avoid audit risks, optimize revenue cycle workflows, and ensure compliance across departments. Critical for C-suite leaders, providers, coders, revenue cycle teams, and compliance teams—this webcast delivers actionable strategies to protect reimbursements and meet federal regulations.
Providers face increasing Medicare audits when using skin substitute grafts, leaving many unprepared for claim denials and financial liabilities. Join veteran healthcare attorney Andrew B. Wachler, Esq., in this essential webcast and master the Medicare audit process, learn best practices for compliant billing and documentation, and mitigate fraud and abuse risks. With actionable insights and a live Q&A session, you’ll gain the tools to defend your practice and ensure compliance in this rapidly evolving landscape.
Dr. Ronald Hirsch dives into the basics of Medicare for clinicians to be successful as utilization review professionals. He’ll break down what Medicare does and doesn’t pay for, what services it provides and how hospitals get paid for providing those services – including both inpatient and outpatient. Learn how claims are prepared and how much patients must pay for their care. By attending our webcast, you will gain a new understanding of these issues and be better equipped to talk to patients, to their medical staff, and to their administrative team.
Hospitals face growing challenges in measuring observation metrics due to inconsistencies in classification, payer policies, and benchmarking practices. Join Tiffany Ferguson, LMSW, CMAC, ACM, and Anuja Mohla, DO, FACP, MBA, ACPA-C, CHCQM-PHYADV as they provide critical insights into refining observation metrics. This webcast will address key issues affecting observation data integrity and offer strategies for improving consistency in reporting. You will learn how to define meaningful metrics, clarify commonly misinterpreted terms, and apply best practices for benchmarking, and gain actionable strategies to enhance observation data reliability, mitigate financial risk, and drive better decision-making.
Copyright © 2025 ICD10monitor. Powered by MedLearn Media.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
