Fraud & Abuse: Feds Focus On Physicians In June Enforcement

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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 a June enforcement snapshot focused on physician-related fraud and abuse matters. It summarizes federal civil and criminal actions involving billing practices, alleged false claims, and settlement activity across multiple specialties and care settings. The piece is relevant to compliance teams, physicians, auditors, and coding professionals who monitor enforcement trends and documentation-related risk.

Why This Topic Matters

It helps readers understand the kinds of billing and compliance issues drawing federal attention, and why those matters can lead to settlements, criminal penalties, and repayment exposure.

Article Sections

  1. Beware of E/M Upcoding Issues

    Discusses a federal settlement tied to physician billing and evaluation-and-management coding scrutiny in multiple care settings. It frames the issue as part of broader fraud enforcement activity.

  2. Other high profile cases

    Summarizes additional enforcement matters involving several specialties and allegations across different kinds of services. The section provides a broader view of the month’s fraud and abuse activity.

  3. Mental health

    Covers a case involving psychiatric and mental health-related billing allegations and related criminal proceedings.

  4. Orthotics

    Covers allegations involving orthotic-related billing, telemedicine consultation activity, and settlement resolution.

  5. Sleep studies

    Covers allegations involving sleep study billing and related conduct occurring outside the United States.

What You Will Learn

  • How federal enforcement actions can involve physician billing and claims issues.
  • What kinds of specialties and services appeared in June fraud and abuse cases.
  • How civil settlements and criminal proceedings can overlap in health care enforcement.
  • What broad compliance themes were highlighted across the month’s cases.

Who Should Read This

  • Physicians
  • Medical coders
  • Compliance officers
  • Billing staff
  • Practice managers
  • Health care attorneys
  • Auditors

Codes Discussed

  • CPT: 99337
  • CPT: 99490

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