tci Medicare Compliance & Reimbursement - 2021 Issue Q3

Industry Notes: Physician Group Settles E/M Upcoding Charges

If you think upcoding now and then is no big deal, think again. A recent Department of Justice (DOJ) settlement shows that the feds take overbilling on E/M services claims seriously. El Paso Ear, Nose & Throat Associates (EPENT) settled its alleged False Claims Act (FCA) violations for purportedly submitting upcoded E/M services claims to Medicare and other federal health programs, a DOJ release says. EPENT agreed to pay DOJ $750,000 to settle the FCA violations. “Providers who line their pockets by over-billing for medical care increase medical costs for all of us and drain critical funds...

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