A quick update on the type of things that the OIG is going after that are very easy for your office fall victim to. Do not let these violations happen to you!
The OIG alleged that a former physician failed to follow policies and procedures for claims submitted to Medicare and Medicaid for services provided by Pediatric Gastroenterology Fellows under her supervision. Specifically, the physician employee occasionally instructed Fellows to use pre-printed forms indicating that she accompanied the Fellows during patient visits. The physician employee used these forms at times when she was present during patient visits, as well as at times when she was not present.
After it self-disclosed conduct to the OIG, the physician, agreed to pay $91,782.50 for allegedly violating the Civil Monetary Penalties Law.
17 Healthcare providers/organizations were found to have employed an individual that knew or should have known was excluded from participation in Federal health care programs. Penalties went from $7,714.68 to $1,053,774.82.
Ask Yourself: Are the staff you have hired able to bill Federal Healthcare programs properly?
The OIG alleged that a physical therapy office improperly billed Medicare under certain CPT codes for physical therapy services when lower reimbursed codes and/or fewer units of these codes should have been. The therapist(s) agreed to pay $18,532 for allegedly violating the Civil Monetary Penalties Law.
The OIG alleged that a physician submitted false or fraudulent claims by using CPT codes that would generate a higher reimbursement than justified by the medical documentation or that he submitted claims without any supporting medical documentation. The physician, agreed to pay $534,000 for allegedly violating the Civil Monetary Penalties Law.
Word to the wise. Stay on top of your billing process. When is the last time that you audited your billing??
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