Doctor Charged with Fraud Pleads Guilty
A physician in Scottsdale, Arizona has pled guilty to performing unnecessary lesion removal procedures on patients, as well as billing Medicaid for services never performed.
The physician knowingly misinformed patients they had suspicious lesions that needed to be removed and had them return frequently for unnecessary procedures. Some of the lesions were destroyed rather than being sent for biopsy according to proper procedure. The physician then reported to Medicare and insurance companies a diagnosis of suspicious or malignant lesions. When coded in the patient record, this diagnosis may follow a patient around for life.
In addition, the physician admitted to billing Medicare for services never performed. He violated the “do no patient harm” oath and accepted more than $480,000 in payments he was not entitled to. He could spend 10 years in prison in addition to repaying the money and paying a large fine.
Ethical coders and billers should be aware of the significant consequences of inappropriate billing both of diagnosis and procedure codes. A diagnosis of malignancy will follow the patients around and may impair them from receiving life insurance or health insurance coverage due to the improper diagnosis codes assigned by this physician.
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