E/M Coding Alert - 2006 Issue 22
FRAUD & ABUSE: Prosecutors Find Nursing-Home Swallow Tests Hard To Digest
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Article Overview
This news item covers a federal fraud-and-abuse case involving radiology and Medicare billing. It focuses on allegations about services performed outside the billed setting, nursing-home swallow testing, and other billed imaging services. The article is relevant to compliance staff, coders, auditors, revenue integrity teams, and providers who work with Medicare claims and diagnostic radiology services.
Why This Topic Matters
It highlights how billing, place of service, and medical necessity issues can create major compliance risk in diagnostic and post-acute care settings. Readers can use it to understand the broader fraud-and-abuse concerns tied to Medicare reimbursement and nursing-home-based testing.
What You Will Learn
- The general compliance issues raised by alleged Medicare fraud in a radiology practice
- How nursing-home-based diagnostic services can create billing and coverage concerns
- Why disputed imaging and swallow-testing claims may draw fraud-and-abuse scrutiny
- The role of Medicare in enforcement actions involving non-covered or unapproved services
Who Should Read This
- Medical coders
- Billing staff
- Compliance officers
- Revenue integrity professionals
- Radiology practices
- Healthcare attorneys
- Auditors
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