Case Studies: Physicians
Physician Evaluation and Management Coding Investigation
BlickenWolf was retained by counsel to perform an independent investigation
of certain physician coding and billing for Evaluation and Management
(E&M)
services provided in a hospital setting. The focus on certain E&M services was the result of allegations raised by a former hospital employee.
Specifically, the employee alleged that hospital management was aware
of inappropriate E&M coding, but did not institute a corrective action plan. Based on our findings,
counsel recommended that the hospital self-disclose all overpayment
amounts that resulted from inappropriate E&M coding and billing to the Office of Inspector General (OIG).
Physician Group Billing Internal Audit
BlickenWolf was engaged by a physician group practice to analyze the
Medicare and Medicaid billing for the group. Internal audits performed
by the group had indicated potential improper billing of those agencies.
Through statistically valid sampling and medical record and billing
document review, we established a statistically valid rate of error
which allowed the group practice to voluntarily return a percentage
of its receipts and avoid a 100% review of all its billings. The
group updated its documentation guidelines and educated the physicians
involved to eliminate future errors.
