Part B Insider (Multispecialty) Coding Alert

Physician Notes:

Unnecessary Services Lead to $5.3 Million Repayment for NY Doctor

Published on Mon Mar 16, 2015

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When coding and billing experts continually remind practices to “put medical necessity first,” they aren’t just blowing smoke. Without a medically necessary reason to perform your services, you could be facing jail time.

A New York physician is learning that lesson the hard way this week after pleading guilty to billing Medicare for $14.2 million in claims for medically unnecessary treatments, the Department of Justice reported on March 6. The doctor has to pay nearly $5.4 million back to the government, and will face sentencing later this year.

The doctor admitted that he and other practitioners at his clinic submitted “false and fraudulent claims to Medicare for medically unnecessary vitamin infusions, physical therapy and occupational therapy that did not qualify for reimbursement by Medicare,” the DOJ said in its statement.

For more on the case, visit www.justice.gov/opa/pr/new-york-doctor-pleads-guilty-142-million-medicare-fraud-scheme.