Part B Insider (Multispecialty) Coding Alert

Physician Notes:

Fraud and Upcoding Net MD 13 Years in Prison, Millions in Returns

Published on Thu Feb 22, 2018

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The feds are on the lookout for outlier activity.

Some believe they can buck the system to cash in on federal money. But recent cases show that if you are caught, enforcement agencies will deliver their wrath with hefty punishments.

The Department of Justice (DOJ) points to greed as the primary factor that led New York-based surgeon, Syed Imran Ahmed, MD, to commit healthcare fraud, filing millions in fraudulent claims and then lying about them to Medicare. "Dr. Syed Ahmed treated Medicare like a personal piggy bank, stealing over $7.2 million by making fraudulent claims for medical procedures he never performed," said Richard P. Donoghue, U.S. Attorney for the Eastern District of New York in a DOJ release on the case. "Dr. Ahmed will now pay the price for violating the trust that Medicare places in doctors."

After reporting to CMS that he'd conducted "wound debridement" services and "incision-and-drainage" procedures that he didn't, Ahmed then claimed he'd performed surgeries that he hadn't and billed Medicare for them, the DOJ release suggested. Furthermore, the surgeon tried to upcode the bogus surgeries by stating their Place-of-Service (POS) as the operating room instead of his office, the report showed.

Result: In addition to paying back the $7,266,008.95 he fraudulently received from Medicare, Ahmed was fined $20,000 and given a 13-year prison sentence for "one count of healthcare fraud, three counts of making false statements related to healthcare matters, and two counts of money laundering," noted the DOJ.

Read the Department of Justice release at: www.justice.gov/opa/pr/new-york-doctor-sentenced-13-years-prison-multi-million-dollar-health-care-fraud.