tci Medicare Compliance & Reimbursement - 2017 Issue 6

Industry Note: Physician's Claims Were a Dead Giveaway That He Was Up to No Good

Alleging a higher-level service than you actually perform results in a false claim — and for a Spokane-area cardiologist that translates to a $300,000 settlement due back to the Feds. In a case that explains the OIG’s need for Comparative Billing Reports (CBRs), Washington cardiologist, Dr. Romeo Pavlic, conducted “cardiac clinics” at Lakeland Village in Medical Lake, a facility devoted to the care of adults with severe physical and mental disabilities. During his short visits, the physician would schedule patients in 5- to 10-minute intervals, seeing as many as 55 residents over a three-hour time span...

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