tci Medicare Compliance & Reimbursement - 2024 Issue Q3

Fraud & Abuse: Feds Focus On Physicians In June Enforcement

Prescription fraud, E/M upcoding, and more factor in latest settlements. You might have noticed that the feds seem to be ramping up their midyear fraud enforcement activity. In fact, June was a particularly busy month with more than 35 civil and criminal actions, including many cases with million dollar price tags and significant prison terms. Read on for the scoop. Beware of E/M Upcoding Issues One practice learned the hard way that submitting higher-level evaluation and management (E/M) codes that don’t support the level of service will land you in hot water. On June 5, Bluestone Physician Services...

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