tci Medicare Compliance & Reimbursement - 2017 Issue 19

Industry Notes: OIG Continues to Hand Out Steep Penalties for Upcoding and False Claims

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 a DOJ brief from Sept. 27. “Cauthon is scheduled to be...

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