A Colorado psychiatry practice recently agreed to pay $1.9 million to resolve allegations from federal prosecutors that it double billed Medicare and Medicaid for patient treatments over four years.
The case originated when an employee of the business reported her suspicions to authorities. That employee was a compliance manager in charge of auditing patient charts and billing codes.
In February 2021, three months after the compliance manager's 18-month employment ended, she and attorneys from the federal government and the states of Texas and Colorado filed a civil suit against Aurora-based Mile High Psychiatry and its owner, Michael Chism, a Centennial resident. Mile High Psychiatry provides mental health services throughout Colorado with nurse practitioners who use remote "telepsychiatry services," as noted in the complaint.
The compliance manager noticed billing codes submitted to Medicare and Medicaid appeared inappropriately upgraded. In particular, the coding deliberately failed to separate evaluation and management services from psychotherapy services, and sought payment for both during the same patient visit.
The compliance manager researched previous patient billing and found the same "fraudulent" and "inflated" billing had occurred since 2017, as described by prosecutors.
"Chism intentionally hired inexperienced and uneducated individuals to perform these coding and auditing functions," as stated in the complaint. "They simply followed Chism's firm...
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