Medicare Compliance & Reimbursement

Last-minute changes to patient records will only make things worse.

There's a high price to pay for careless coding -- but an even higher one for covering it up.
 
Paul Elliott, president and part-owner of Doctor's Care Medical Center, Inc., was convicted March 5 of billing Medicare and Blue Cross of Florida for hundreds of tests that were more comprehensive than the ones actually performed.

Through several Doctor's Care clinics in southeast Florida, prosecutors charged Elliott with submitting claims totaling more than $320,000 for MRIs requiring a contrast medium when none was allegedly used, and also for electromyography tests when less intrusive nerve conduction velocity tests were done instead.

According to U.S. Attorney Marcos Daniel Jimnez, Elliot faces 22 counts of health care fraud -- with a possible 10-year prison stint and a $250,000 fine on all counts. The doctor is also eligible for an additional 20 years and more fines after alleged attempts to alter 169 patient records on the EMG claims backfired into an obstruction of justice charge.

Lesson Learned: With tough prison time at stake for providers, a compliance plan ahead of time is a safer bet than an emergency plan afterward.