Outpatient Facility Coding Alert - 2016 Issue 23
Industry Note: Psychiatrist Must Pay Back $908,000 for False E/M Claims
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Article Overview
This article summarizes a Department of Justice enforcement update involving alleged false evaluation and management claims submitted by a psychiatrist in Illinois. It is relevant to coding, compliance, auditing, and billing professionals who track Medicare-related risk, documentation concerns, and enforcement trends in physician services.
Why This Topic Matters
It highlights the compliance and payment risks associated with evaluation and management billing, especially in long-term care environments, and shows how federal enforcement actions can affect reimbursement and program participation.
What You Will Learn
- The general compliance issue addressed in the enforcement update
- Why evaluation and management billing can attract audit and legal scrutiny
- What types of organizations and payment programs are referenced in the note
- How federal enforcement actions can affect provider participation in healthcare programs
Who Should Read This
- Medical coders
- Billing specialists
- Compliance officers
- Auditors
- Physicians
- Practice managers
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