Two Georgia dermatologists will pay nearly $2 million to settle charges that they unnecessarily stretched out simple procedures over several office visits – and billed E/M codes each time.
Margaret Kopchick, M.D., and Russell Burken, M.D., and their practice, Toccoa Clinic Medical Associates, will pay $1.9 million to settle a False Claims Act case, the U.S. Attorney’s Office for the Northern District of Georgia announced on April 19.
The charges were originally brought in 2012 in a complaint alleging multiple medical scams.
Kopchick and Burken were turned in by whistleblower employee Rachel Jimenez, part of whose job, the complaint alleged, was to laser patients’ seborrheic keratosis lesions. While Medicare specifies CPT code 17111 for a procedure that lasers 15 or more such lesions “whether the doctor removes 15 lesions or 100 lesions,” Kopchick allegedly decreed that no more than five lesions could be removed at a time – leading to many patients “having to return every few weeks,” per the complaint, with Kopchick and Burken billing the lower-volume 17110 code each time.
On occasion, the doctors would “allow patients to have up to an additional 10 lesions removed but charge them an additional $10 per lesion.” Also, when patients received photodynamic therapy for these lesions on their arms, the doctors allegedly insisted only one arm be treated per visit so they could bill a second time.
At the same time, the doctors allegedly charged for office visits along with the procedures, which appears to have been their downfall: The Department of Justice press release on the settlement says the doctors were “billing Medicare for evaluation and management (E/M) services that were not permitted by Medicare rules. … Providers are not permitted to bill both E/M services and a procedure on the same day under the Medicare program’s regulations unless a significant, separately identifiable service has been performed.”