Part B Insider (Multispecialty) Coding Alert

Plus: Texas physician sentenced to 12 years in prison for Medicare fraud.

Looking for a boost in your Medicare Advantage payments? CMS is prepared to oblige, but won’t be offering as much as most practices had previously been hoping.

Effective Jan. 1, 2017, CMS will raise Advantage payments by 0.05 percent, although this is a bit lower than CMS’s previous projection, which had the raise projected at 1.35 percent. “The final revenue increase is somewhat smaller than the increase estimated in the February Advance Notice due primarily to technical updates in the risk adjustment normalization factor,” CMS said in an April 4 statement about the payment changes. In addition, Medicare officials said in a Fact Sheet that practices will see an overall “expected average change in revenue” of 3.05 percent, which could significantly impact practitioners’ bottom lines.

Resource: To read the complete announcement of the 2017 updates, visit www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releases-items/2016-04-04.html.

In other news…

You’ve heard the saying “If it wasn’t documented, it wasn’t done.” But in the case of a Texas psychiatrist, the saying should have been, “Even if it was documented, it wasn’t done.” That’s what the government suggested in a recent case that will land the physician in jail for up to 12 years.

The psychiatrist was sentenced on April 1 to 144 months in prison and must pay restitution of $6.3 million back to the government for her role in a health care fraud case, which also apparently involved making false statements related to health care matters, according to a Department of Justice news brief.

Between 2006 and 2012, the doctor is said to have submitted about $158 million in false claims to Medicare for partial hospitalization program (PHP) services, the government indicated. “The evidence presented at trial showed that the Medicare beneficiaries … did not receive PHP services.  In fact, evidence proved that most of the Medicare beneficiaries rarely saw a psychiatrist and did not receive intensive psychiatric treatment at all,” the DOJ statement said.

Evidence also revealed that the doctor billed for individual psychotherapy and other services, but the jury determined that she never provided the services. In addition to the psychiatrist in question, 12 additional health care professionals have been charged in the same scheme.

Resource: To read more about the case, visit www.justice.gov/opa/pr/houston-psychiatrist-sentenced-144-months-prison-role-158-million-medicare-fraud-scheme.

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