E/M Coding Alert - 2013 Issue 42
Physician Notes: Prominent Cardiologist Faces Over 6 Years in Prison
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Article Overview
This article summarizes two Medicare-related developments: a criminal case involving a cardiologist accused of widespread fraudulent testing and billing, and a CMS change request affecting how certain inpatient hospital claims are reviewed when hospice information is involved. It is relevant to compliance, hospital billing, hospice billing, audit response, and health care fraud monitoring. The article also references guidance from the Department of Justice, CMS, Recovery Audit Contractors, and the National Association for Home Care & Hospice.
Why This Topic Matters
The page highlights both enforcement risk in physician ordering and documentation practices and a Medicare claims-edit change that may affect hospital and hospice reimbursement workflows. Readers focused on compliance, audit readiness, and billing operations can use it to assess whether the full article is relevant to their work.
Article Sections
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Physician fraud case and sentencing
A reported criminal case involving a cardiologist, allegations of fraudulent testing and charting, and the resulting enforcement actions and penalties.
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Medicare inpatient hospital billing edit involving hospice claims
CMS guidance on a new inpatient hospital claims edit related to hospice periods, billing review activity, and implementation timing.
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Operational and audit implications
Discussion of review activity, potential retroactive claim review, and the practical effects of the Medicare change for providers.
What You Will Learn
- The article’s focus on physician compliance and health care fraud enforcement
- How CMS is changing review of certain inpatient hospital claims
- The types of organizations and audit bodies involved in the billing change
- Why the article may matter to hospital, hospice, and compliance teams
Who Should Read This
- Medical coders
- Hospital billing staff
- Hospice billing staff
- Compliance officers
- Revenue cycle managers
- Physician practice administrators
- Health care auditors
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