Thank you very much for your reply and I agree with your speculations as to why's of managements focus.
The one issue I have is: I want to be able to present to them the actual Medicare documentation substantiating the "correctness" of my actions. I have acknowledged (and will) process services as they've directed but I would like to have validation my approach is an appropriate and legal process.
Within CMS I could only find the False Claims Act definition (below). Where would I be able to obtain something more specific?
This is what I presented:
The charging of a surgical assist, when it is properly documented, and which CMS states is not eligible for reimbursement, is not considered false claims. It is not acting “in deliberate ignorance or reckless disregard of the truth or falsity of the information related to the claim”. Submission of a claim for services appropriately rendered, documented, and coded does not constitute false or fraudulent. When submitting the surgical assist to Medicare for an assist that is not covered by Medicare, you’ll get a rejection. Nothing more.
Directly from CMS -
Federal False Claims Act (FCA)
The FCA protects the Federal Government from being overcharged or sold substandard goods or services. The FCA imposes civil liability on any person who knowingly submits, or causes the submission of, a false or fraudulent claim to the Federal Government. The terms “knowing” and “knowingly” mean a person has actual knowledge of the information or acts in deliberate ignorance or reckless disregard of the truth or falsity of the information related to the claim. No proof of specific intent to defraud is required to violate the civil FCA.