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Part B Insider (Multispecialty) Coding Alert
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Physician Notes: Family Physician Could Face 10 Years in Prison Over Fabricated Charts


- Published on Mon, Aug 17, 2015

If you’re planning to bill Medicare for visits with patients, ensure that you actually perform the visit first. That’s the word from a recent Department of Justice (DOJ) case involving a New Jersey family physician.

The doctor plead guilty this week to billing Medicare, Medicaid and other payers for face-to-face office visits that didn’t actually take place. He “admitted that he also altered patients’ medical charts by inserting fabricated blood pressure readings, other vitals and clinical notes on patients’ charts to make it appear as if they had visited his office on the billed dates,” the DOJ said in an Aug. 10 news release.

The doctor confessed to taking about $280,000 from insurers over a four year period under the scheme, the DOJ added. Consequently, he faces up to ten years in prison and a fine of $250,000 or more—his formal sentencing will take place in November.

Resource: To read more on the case, visit www.justice.gov/usao-nj/pr/bergen-county-new-jersey-doctor-admits-billing-bogus-office-visits-altering-patient.

In other news...

The Senior Medicare Patrol (SMP) project continues to educate beneficiaries about potential fraud and abuse they may encounter. In 2014, the 53 SMP projects had 5,194 active volunteers that conducted 202,064 one-on-one counseling sessions, 14,618 group education sessions attended by 450,720 beneficiaries, and 12,290 community outreach education events, the OIG says in a recent report. The projects also conducted 110,410 media airings.

The OIG estimates recoveries attributable to the projects were $661,333, savings to beneficiaries and others totaled $80,228, and cost avoidance on behalf of Medicare, Medicaid, beneficiaries, and others was $200,598. See the report at http://go.usa.gov/3A4xR.






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