Bungling unbundlers in Manchester and Mobile

by: Julia Kyles, CPC Jun 29, 2017

Doctors in Manchester, Maine, and Mobile, Ala., will have to pay up to resolve allegations related to the improper unbundling of Correct Coding Initiative edits.

In Manchester, Maine a physician will pay $133,464 to resolve allegations that he improperly billed for E/M services.

Dr. Landry was not entitled to be paid for those E/M services because they were provided in connection with, and integral to, osteopathic manipulative treatment Dr. Landry performed on the same day. In total, Dr. Landry received $66,732 from the Medicare Trust Fund to which he was not entitled. The settlement amount represents twice the amount of damages incurred by the Medicare program.

The alleged scheme in Mobile, Ala. was a more complicated, perhaps because more physicians were involved. The acting U.S. attorney for the Southern District of Alabama alleged that a physician, his medical practice and a group of neurosurgeons had engaged in a number of fraudulent activities, which included medically unnecessary services, falsified diagnoses and:

The United States further alleged that CNI, Crumb, and other CNI physician employees unnamed in the lawsuit, knowingly manipulated billing codes in order to circumvent safeguards implemented by Medicare’s National Correct Coding Initiative to combat improper and fraudulent duplicate claim line billing of certain procedure codes, including ultrasound guidance used with needle placement.

The doctors accused of the fraud will pay a $1.4 million settlement.

Blog Tags: anti-fraud, compliance

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