FRAUD & ABUSE: Consults, NPP Billing Lead To Big Payouts

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This article reviews selected fraud and abuse cases highlighted in an HHS Office of Inspector General report. It focuses on billing and documentation concerns involving incident-to services, consults, place of service, and related enforcement actions against physicians and other providers. The piece is aimed at readers who monitor compliance risk, billing oversight, and audit exposure in physician practices.

Why This Topic Matters

It helps readers recognize common compliance risk areas that can trigger repayments, exclusions, audits, and other enforcement actions in physician billing environments.

What You Will Learn

  • The general fraud and abuse themes emphasized by the HHS OIG
  • How incident-to billing and consult-related issues appear in enforcement discussions
  • Why place-of-service and documentation concerns are compliance risks
  • How enforcement summaries can inform billing compliance review priorities

Who Should Read This

  • Physicians
  • Medical practice managers
  • Coders and billers
  • Compliance officers
  • Revenue cycle professionals

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