Part B Insider (Multispecialty) Coding Alert

Published on Fri Feb 15, 2013 PDF

Providers who intend to submit claims to Medicare should at least confirm that their clinic was actually open on the date of service. That’s a lesson learned by a nurse who was busted for fraudulent billing after the Department of Justice nabbed him for falsifying records to make them look like patients were eligible for mental health care when they weren’t. In addition, the nurse submitted claims on dates that his facility was closed for a snow day, and routinely submitted claims for patients that weren’t present.

The nurse also admitted that he was involved in a money laundering scheme, and is accused of providing kickbacks. He faces 111 months in prison and three additional years of supervised release. To read the entire press release about the case, visit http://www.justice.gov/opa/pr/2013/February/13-crm-181.html.