E/M coding without proper documentation will cause trouble

On July 3, 2013, the United States Department of Justice announced Sound Inpatient Physicians, Inc. (“Sound Inpatient”) will pay $14.5 million dollars to settle allegations that it over-billed Medicare and other federal health care programs. The Washington-based company employs more than 700 hospitalists and post-acute physicians to facilities in twenty-two states.

Under the whistleblower provisions of the False Claims Act (“Act”), a former Sound Inpatient regional manager alleged the company was submitting evaluation and management (“E/M”) claims for reimbursement that were unsupported by medical documentation. The government then intervened; no surprise, considering that since January 2009, the Justice Department has recovered a total of more than $14.7 billion through False Claims Act cases.

Read more:

http://www.natlawreview.com/article/sound-inpatient-s-unsound-practices-lead-to-145-million-settlement

About the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.