tci Medicare Compliance & Reimbursement - 2007 Issue 25

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

Incident-to billing and POS still under OIG's microscope.Three physicians agreed to repay $1 million after they allegedly billed for services that nurse practitioners and physician assistants provided. The physicians billed for the services as though they provided them personally. Also, a Pennsylvania cardiologist repaid $435,000 after the government claimed he was billing consults that didn't meet the definition of a consult, or lacked proper documentation. The feds also claimed he billed for evaluation & management services that were already covered in his payment for nuclear stress testing.Beware: Those are just two of the horror stories in...

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