We read recently of a radiation therapy provider that agreed to pay more than $3.5 million in a CMP (civil monetary penalty) settlement with the OIG (Office of Inspector General).
According to the settlement, the company submitted claims for radiation and oncology services that:
In general, the AMA says, medical billing errors fall into one of two broad categories: fraud or abuse.
The AMA’s “Principles of CPT Coding” offers definitions of the terms: Fraud “involves intentional misrepresentation,” while abuse means “the falsification was an innocent mistake, but nonetheless representative.”
The organization also lists some common medical-coding errors to avoid:
To avoid those kinds of mistakes, contact an attorney experienced in representing clients in Medicare and insurance audits, as well in crafting compliance plans.