Primary care physicians, a surgeon, and one of New York’s leading opioid prescribers were among the latest doctors involved with investigations by the U.S. Department of Health and Human Services’ Office of Inspector General.
Two primary care physicians agreed to pay $1.5 million plus interest to resolve False Claims Act allegations they misrepresented the severity of illnesses and services to boost reimbursement from Medicare Advantage and Medicare Part B. The U.S. Attorney’s Office for the Eastern District of Pennsylvania announced the case.
Complete Physician Services (CPS), with Kenneth Wiseman, DO, and Steven Schmidt, DO, of Philadelphia, treated Medicare patients, but from January 2015 to the end of 2018, submitted unsupported diagnosis codes for patients that had a body mass index less than 35, according to the federal lawyers. Additional diagnoses of chronic obstructive pulmonary disease were not medically supported or documented, and the physicians billed for a Current Procedural Terminology Code without requisite levels of decision-making.
“Almost half of Medicare beneficiaries are now enrolled in Medicare Advantage plans. Investigation of credible allegations of fraud impacting it is more important than ever,” U.S. Attorney Jacqueline C. Romero said in an announcement. “The Medicare Advantage Program relies on accurate information about its enrollees’ health status, such as whether they really have morbid obesity or COPD. It is...
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