HEALTHCARE MEDICAL CODING AND BILLING FRAUD PROBLEMS

Category: Health

As announced by the United States Attorney’s Office District of Masachussetts, CareWell Urgent Care Centers has approved to pay $2 Million in order to resolve the dispute apparently. The allegation was that they violated the False Claims Act because, the claims submitted to Medicare, MassHealth, GIC and Rhode Island Medicaid were found to be false, apparently inflated the level of E/M services. Therefore, it calls for the need to improvise the Medical coding practices and the related issues as well as associated possible frauds. The government bodies that were bringing claims against CareWell suspected that the company has unnecessarily urged the patients to go ahead with the unwanted examinations which were irrelevant to the patient’s body condition. The staff was instructed to prepare a questionnaire with “Yes/No” type of questions even if that particular question was not medically relevant, it has thereby created a format wherein the tests seemed to be conducted though in reality, it was not. As it is a fact that the Evaluation and Management (E/M) services at the center of fraud are dogged by a procedural terminology codes, these codes described by the body systems that a practitioner must review such as to diagnose the patient’s condition and the line of treatment. Urgent Care centers are supposed to submit these codes for services and later provide the claims which reveal the services including that type of person p nurse or practitioner etc., where the care was administered. Such allegations show the need for thoroughness in the coding procedures.