On February 18, 2014, the U.S. Attorney’s Office for the District of Maryland announced that a medical billing company, its owner, and three Maryland medical practices that were clients of the medical billing company have agreed to pay a total of $3,340,979.50 to resolve claims that the medical billing company overbilled Medicare, other federally funded health insurance programs, and other health insurance providers for nuclear stress tests.
The medical billing company and its owner agreed to pay $544,500; a cardiology practice and its owners agreed to pay $1,894,549.50; an internal medicine practice group and a physician agreed to pay $242,204; and, another physician agreed to pay $659,726.
The alleged Medicare overbillings involved nuclear stress tests designed to assess cardiac function that were conducted between July 31, 2007 and March 8, 2011. The medical billing company marketed its medical billing services to physicians and physician practices by persuading them to perform the nuclear stress tests in the physicians’ offices instead of referring the patients to cardiologists for the tests, thereby increasing the physicians’ income. The medical billing company would obtain patient medical records from the physicians and then have its staff of medical coders in India apply the relevant Current Procedural Terminology codes (“CPT codes”) for billing to Medicare and others.
It was alleged that the medical billing company systematically billed for each service twice, using a CPT code modifier intended to be used when the service had been repeated by the same physician or when a distinct service was performed on the same day, even though none of the tests were repeated and none of the tests were a distinct procedural service.
It was also alleged that the medical billing company engaged in improper “unbundling,” which involves adding additional CPT codes for services that are already included in the CPT code for the nuclear stress test (such as for interpreting and reporting the test results). The additional CPT codes resulted in unjustified higher payments being received from Medicare and other federally insured medical programs.
The cardiology practice that settled the claims against it and its three owners allegedly hired the medical billing company to re-bill claims for nuclear stress tests that it had previously performed, billed, and for which it had received payments. The medical billing company resubmitted the prior nuclear stress tests for payment a second time, using the CPT codes that reflected a distinct or repeat service, and also added the unbundled code for interpretation. After February 2010, the cardiology practice allegedly continued the improper practice by using its own medical billers to apply the CPT codes to current billings for nuclear stress tests that its cardiologists performed.
In announcing the settlement, the U.S. Attorney for the District of Maryland stated, “When medical providers can enrich themselves at taxpayers’ expense by falsely representing that they provided expensive procedures, the government must be vigilant in pursuing fraudulent claims. Anyone who knowingly reports false medical billing codes to induce the government to pay more money is lying, cheating and stealing.”
If you or someone you know may have suffered injuries or death as a result of medical malpractice in Maryland or in another U.S. state, you should promptly consult with a local Maryland medical malpractice attorney or a medical malpractice attorney in your state who may investigate your medical malpractice claim for you and represent you in a medical malpractice case, if appropriate.
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