tci Medicare Compliance & Reimbursement - 2016 Issue 9

Industry Note: Rampant E/M Overbilling Prompts Violations and Millions in Fines

The Department of Justice (DOJ) continues to crack down on fraudulent E/M claims. The law clearly states that “providers are not permitted to bill both E/M services and a procedure on the same day under the Medicare program’s regulations unless a significant, separately identifiable service has been performed.” But in one recent case, a group of Georgia dermatologists repeatedly “upcoded E/M services to higher levels than were appropriate, leading to overpayments by Medicare.” The practice was found guilty and is forced to pay back the false claims — $1.9 million — under the...

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