tci Part B Insider - 2009 Issue 26

In other news ...

• Modifier misuse allegations might be partly responsible for one physician's legal troubles. A New Jersey practice allegedly overbilled Medicare by almost $5 million by fraudulently reporting lymphedema procedures to its carrier.Although the practice billed for surgery that the physician personally performed, investigators charged that unsupervised physical therapists, licensed practical nurses, and massage therapists were performing physical therapy services on the patients rather than surgeries. The attorneys allege that the physician certified that the services were medically necessary, and used inappropriate modifiers and CPT codes to report multiple procedures within a short time period, according to a July...

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