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Illinois Physician Settles Case Involving False Claims

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Illinois Physician Settles Case Involving False Claims

The settlement agreement resolves allegations that Dr. Tolitano submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 93965, when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which Dr. Tolitano submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service.

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Texas Physician and Practice Settle Case Involving False Claims

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Texas Physician and Practice Settle Case Involving False Claims

The settlement agreement resolves allegations that Dr. Robbins submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 93965, when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which Dr. Robbins submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service.

 

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New Mexico Physician and Practice Settle Case Involving False Claims

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New Mexico Physician and Practice Settle Case Involving False Claims

The settlement agreement resolves allegations that Dr. Reddy submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 93965, when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which Dr. Reddy submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service.

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Texas Physician Guilty in $325M Fraud Case Involving False Diagnoses

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A Texas physician was found guilty Jan. 15 for his role in a $ 325 million healthcare fraud scheme that involved falsely diagnosing patients with various degenerative diseases and then administering chemotherapy and other toxic drugs to patients based on the false diagnoses, according to the Department of Justice.

After a 25-day trial, Jorge Zamora-Quezada, MD, was convicted of one count of conspiracy to commit healthcare fraud, seven counts of healthcare fraud and one count of conspiracy to obstruct justice.

Dr. Zamora-Quezada was charged in an indictment unsealed in May 2018. In addition to falsely diagnosing patients and administering unneeded drugs, he also allegedly conducted a battery of other fraudulent and excessive medical procedures on patients to increase revenue and fund his opulent lifestyle. Many patients, some as young as 13, suffered physical and emotional harm as a result of the false diagnoses and unnecessary procedures and chemotherapy injections, according to the Justice Department.

Read the full story on Becker’s Hospital Review here.

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Connecticut Diagnostic Services Provider Settles Case Involving False Claims

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On November 19, 2018, Southern Connecticut Vascular Center, LLC (SCVC), Stratford, Connecticut, entered into a $ 792,076.76 settlement agreement with OIG. The settlement agreement resolves allegations that SCVC submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 96965 when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which SCVS submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service. The OIG further contends that the submission of claims for HCPCS code 93965 were for a procedure that should not have been separately billed and was not medically necessary. Senior Counsels Geoffrey Hymans and Joan Matlack, with the assistance of Program Analyst Mariel Filtz, represented OIG.

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California Physician and Practice Settle Case Involving False Claims

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On December 20, 2018, Michael Jadali, D.O., and the Center for Pain & Rehabilitation Medicine (collectively, “Dr. Jadali”), San Jose, California, entered into a $ 60,406.30 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Jadali submitted claims to Medicare for Healthcare Common Procedure Coding System codes 80500 (clinical pathology consultation; limited, without review of patient’s history and medical records) and 80502 (clinical pathology consultation, comprehensive, for a complex diagnostic problem, with review of patient’s history and medical records), where no consultation request had been made, no written narrative report by a consultant pathologist was produced, and no exercise of medical judgement by a consultant pathologist was required. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.

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Complicated Coding issue involving Cataract surgery on a juvenile for PCS Cataract su

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I would like some Coding help in determining What CPT’s and what current ICD-10 Codes can be billed for cataract surgery with sulcus lens placement, pars plana vitrectomy, with lens implant retrieval of implant that dropped into the vitreous space during surgery, right eye. This is complicated in that the cataract surgery was performed by the Primary Ophthalmologist on a juvenile patient for PSC cataract OD and then this patient experienced a posterior capsule rupture during I & A necessitating pars plana vitrectomy with lens implant retrieval by another Ophthalmologist, who is the Retinal Surgeon in the same Ophthalmology Practice. Also, can this be coded as a Two-Surgery Case with a -62 modifier on each surgery? Also, the CPT Codes the Retinal Surgery said to use for his portion of the surgery were 67036, 67121, and 66986.

Which modifiers would I use for each surgery for each provider?

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