Part B Insider (Multispecialty) Coding Alert

Physician Notes:

Couple Gets Prison Time for Masquerading as Physicians in Portable X-ray Scam

Published on Mon Aug 22, 2016

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Plus: CMS Releases 2014 Part D Drug Data

The use of portable imaging has skyrocketed in recent years due to its convenience and the necessity to reach more patients in a variety of settings from clinics to nursing homes to home health facilities. Garnering the images is a two-part system—first, a physician orders the initial service, then a licensed physician reads and interprets the images.

A New Jersey couple—owners of two separate imaging companies—were caught in the act of posing as reading physicians from 2006 to 2014, falsifying documentation, and collecting over $4.8 million from Medicare and other insurance companies. The husband-and-wife team used their illegally begotten funds on “multiple residences and luxury vehicles,” an August 16, 2016 OIG report states.

“The companies provided mobile diagnostic testing, including ultrasounds, echocardiograms and nerve conduction studies that were used to diagnose heart defects, blood clots, abdominal aortic aneurysms and other serious medical conditions,” the OIG report said. The husband-and-wife team did not have medical training, furthermore the DOJ investigators found “more than 10,000 diagnostic reports generated between Oct. 2008 and June 2014 were never actually reviewed or interpreted by a physician.”

Due to the magnitude of the crime, the couple will be spending five years in prison, paying $5 million in damages and $2.75 million in civil penalties.

Resource: For a look at the OIG report, visit www.justice.gov/usao-nj/pr/morris-county-new-jersey-husband-and-wife-sentenced-prison-falsifying-thousands-medical.

In other news…

It’s pretty obvious to consumers everywhere that the cost of prescription drugs has risen to astronomical heights. For those beneficiaries covered under Medicare Part D, that price tag is usually kept within certain economic limits. But, the costs have risen even with the Part D benefits, and recent data shows that there’s a marked increase in the number of prescriptions handed out.

“The 2014 data set contains information from over one million distinct health care providers who collectively prescribed approximately $121 billion in prescription drugs paid for under the Medicare Part D program,” an Aug. 18, 2016 CMS news release detailed. “This represents a 17 percent increase compared to the 2013 data set.”

With OIG reports showing this past six months that the abuse of prescription drugs and the overprescription of them is on the rise, CMS is releasing the data to let both providers and beneficiaries see the trends and concer. Since over 70 percent of Medicare subscribers utilize Part D, it is of great importance to study the research, gain input, and reevaluate the system.

“With this data release, patients, researchers and providers can access valuable information about the Medicare prescription drug program,” Niall Brennan, CMS Chief Data Officer said in the press release. “Today’s release joins a series of actions the Administration is taking to improve transparency around government data, including the cost of prescription drugs.”

Resource: To review the CMS press release with links to Part D fact sheets, visit https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releases-items/2016-08-18.html.