Part B Insider (Multispecialty) Coding Alert

Published on Mon Oct 05, 2015 PDF

If you thought the government went after medical practitioners for fraud, think again.

On Sept. 18, the Department of Justice announced that a Chicago medical biller faces 45 months in prison after being convicted of health care fraud. The biller “routinely billed Medicare for overseeing patient care plans (a service known as ‘care plan oversight) when, in fact, the doctors at the organization rarely provided the service,” the DOJ said in a news release. She also billed Medicare for services rendered to deceased patients and even coded using the ID numbers of practitioners who no longer worked at the practice.

Based on the fraudulent claims, the biller submitted line items for $4 million in services that weren’t actually provided over the course of five years. She is now required to pay $1 million back to the government in restitution.

Resource: To read more about the case, visit www.justice.gov/opa/pr/medical-biller-sentenced-45-months-prison-role-4-million-health-care-fraud-scheme. 

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