Part B Insider (Multispecialty) Coding Alert

Published on Fri Feb 21, 2014 PDF

You’re aware of the fact that the government could charge you with Medicare fraud if you submit false claims to CMS—but did you know that those charges could lead to a full web of accusations? A Texas physician learned that the hard way last week when he pleaded guilty to mail fraud in connection with fraudulent billings that he submitted, since he collected his Medicare checks via the U.S. Postal Service.

The doctor billed for medical services he claimed to have administered to patients who were actually deceased at the time of service. In addition, he submitted claims for services that took place when he was out of the country, and charged for office hours that would have had him working for more than 24 hours in a single day. “Court documents also alleged that when he provided medical services to Medicare and Medicaid patients in nursing homes, he would send fraudulent bills claiming he had seen the patients in private residences in order to collect the higher fees paid for house calls,” the Department of Justice said in a Feb. 18 news release.

The physician faces up to 20 years in prison and up to $250,000 in fines. You can read the complete news release at www.justice.gov/usao/txs/1News/Releases/2014 February/140218 - Ramirez Jr.html.