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.
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 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.