If your doctors ever give you a hard time about how long it takes to document fully, you may want to remind them the kind of hard time they’d face in the slammer.
One
now notorious case involves a “respected surgeon” whose E/M coding and documentation resulted in him being charged with two counts of Medicare fraud and two counts of making false statements.
While the surgeon was acquitted of fraud, he was convicted of making false statements in his documentation and is currently serving a 10-month prison sentence.
In another jaw-dropper, the University of Illinois Hospital and Health Sciences System and Mount Sinai Hospital in Chicago is being forced to return $145 million in Medicaid overpayments – for services rendered 13 years ago.
“Clearly, the wolves are at the door,”
writes Barbara Aubrey, RN, CPC, a regulatory analyst for the health information arm of 3M, the giant multinational conglomerate. “They know who you are and what you’re doing.”
What you can do about it: You need to take a long, hard look at your E/M billing and internal protections. Nobody is safe doing occasional manual audits on Excel sheets anymore. You need a tool, and a way to benchmark your providers.
Check out this free July 9 webinar on an E/M chart auditing tool that does both (
FREE – 1.0 CEUs from the AAPC!). You’ll also learn about the aggressive, data-driven auditing by the OIG, and how compliance officers are fighting back with a top-selling audit tool.