Medicare Compliance & Reimbursement

Upcoding leads to weekends behind bars Health care fraud enforcers are using the latest trends in criminal sentencing to lay down the law on compliance violations. According to New York Attorney General Eliot Spitzer, Bath, NY physician Dr. Ashar Tahir, after pleading guilty to fraud charges July 23, agreed to a sentence of six months' "shock probation," community service and five years probation. Shock probation means Dr. Tahir will be incarcerated during the weekends, and spend weekdays under electronic home monitoring. According to prosecutors, Tahir submitted bogus reimbursement claims to Medicare, Medicaid and another payer in which he overstated the extent of the services he provided. As part of the plea agreement, Tahir will make more than $650,000 in restitution. If Tahir violates the terms of the agreement, he could face up to seven years in prison. Lesson Learned: Exaggerating the level of services you provide could land you behind bars - so make sure your compliance program will stop inappropriate claims before they leave your office.