Part B Insider (Multispecialty) Coding Alert

Published on Thu Mar 28, 2013 PDF

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A Missouri physician and her husband are facing penalties after pleading guilty to upcoding and falsifying claims at their medical clinic.

The physician worked as the medical director and her husband was the CEO of a clinic that specialized in diagnosing and treating chronic diseases such as fibromyalgia and Lyme disease, the Department of Justice reported in a March 22 news release.

The couple pleaded guilty to billing for physician visits when the physician was actually out of town, billing for visits when she was not involved with the patient, and billing for office visits when the doctor only provided a phone call. In addition, she billed for physician-supervised services when no doctor was on duty, and improperly billed consultations. In total, the clinic overbilled by about $359,168, for which they were paid $51,789 in reimbursements that they didn’t deserve, which they must pay back to the government.

The couple also filed false tax returns that didn’t include all of their income. The physician will permanently lose her license and will face three years of probation. Her husband will be sentenced to 24 to 30 months in federal prison.

To read the complete press release, visit www.justice.gov/usao/mow/news2013/ryser.ple.html.