tci Medicare Compliance & Reimbursement - 2003 Issue 39

DME: HOW ONE SUPPLIER BEAT OFF THE FEDS IN A WHISTLEBLOWER SUIT

A False Claims Act case is on shaky ground when on one is clear on coding rules. Using the wrong code when billing Medicare for medical equipment isn't a de facto violation of the False Claims Act - even when the code pays more than what the feds maintain is the proper code. The key is whether proper instructions are issued to contractors, providers and suppliers on how to bill for a particular item. That's the upshot of a recent court ruling from the U.S. District Court for the Northern District of Texas. The ruling stems from a...

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