tci Part B Insider - 2017 Issue 11

Physician Notes: Upcoding and False Claims Continue to Garner Big Penalties from the OIG

Plus: The QRUR review period is "informally open," according to CMS. Upcoding is a focus area for the HHS Office of Inspector General (OIG), and often is the first offense that leads investigators to uncovering more serious crimes. A recent Department of Justice (DOJ) case found Murfreesboro, Tennessee Podiatrist John J. Cauthon guilty of Medicare fraud after running a false-claims scheme between May 2014 and August 2015. Among his offenses were prescriptions for ankle braces that were medically unnecessary, routine foot care upcoded to nail avulsions, and the submission of claims for surgical procedures he never performed, said...

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