Medicare Compliance & Reimbursement
Industry Notes
Missouri Doctor Faces Sentence for Chronic Upcoding
A Missouri physician and her husband are facing penalties after pleading guilty to upcoding and falsifying claims at their medical clinic.
Carol Ann Ryser worked as the medical director and her husband, Michael Earl Ryser, was the CEO of Health Centers of America-Kansas City, a clinic that specialized in diagnosing and treating chronic diseases such as fibromyalgia and Lyme disease, the Department of Justice reported in a March 22 news release.
The couple pleaded guilty to billing for physician visits when the physician was actually out of town, billing for visits when she was not involved with the patient, and billing for office visits when the doctor only provided a phone call. In addition, she billed for physician-supervised services when no doctor was on duty, and improperly billed consultations. In total, the clinic submitted fraudulent claims totaling $359,168, for which they received $51,789 in reimbursements. The couple has been ordered to pay back the $51,789 in restitution to the health care benefit programs they defrauded.
The couple also filed false tax returns that didn’t include all of their income. The physician will permanently lose her license and will face three years of probation. Her husband will be sentenced to 24 to 30 months in federal prison.
To read the complete press release, visit www.justice.gov/usao/mow/news2013/ryser.ple.html.
CMS Declares Claims Hold
Errors in this month’s Medicare claims system update could affect your cash flow. The Centers for Medicare & Medicaid Services has detected “technical issues” that affect certain provider claims, including home health final claims, it says in a message to providers. The problems affect only claims with dates of service April 1 or later.
“As a result of these issues, CMS has instructed its Medicare claims administration contractors to hold [these claims] until April 14, 2013, when system fixes are expected to be implemented,” the agency says. “These claims will be released into processing on April 15, 2013.”
Hopefully, most home health agencies won’t see a significant impact, since Medicare’s 14-day payment floor would keep claims dated April 1 from paying before April 15 anyway.
However: Keep an eye out to make sure the fix actually works as expected and the held claims process timely, experts caution.
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