‘Show and Tell’ in Medical Billing

Recent court cases are cautionary tales for medical practices

Two recent settlements with the Department of Justice read like a ‘show and tell’ about what to do and what not to do in medical billing.

Honolulu-based physical therapist Garrett Okubo was indicted in April by the DOJ for billing the Hawaii Medical Service Association, Tricare, Medicare and Medicaid for physical therapy at his business, P.T. On the Go. Why the indictment? Okubo wasn’t performing the physical therapy services, and those employees who did perform the services weren’t licensed.

Billing rule number one: Make sure the provider listed on the claim performed the service. Breaking this rule resulted in monetary penalties and jail time for Okubo.

A second Department of Justice suit, filed against laboratory testing company Biotheranostics of San Diego, was settled for $2 million. The company was indicted for submitting Breast Cancer Index (BCI) tests to Medicare that weren’t deemed reasonable or necessary for the diagnosis and treatment of breast cancer based on published clinical trial data and clinical practice guidelines.

Billing rule number two? Make sure any tests performed are reasonable and necessary according to current guidelines. “Laboratories that knowingly submit claims for non-reimbursable services will be held accountable,” said Acting Assistant Attorney General Chad A. Readler of the Justice Department’s Civil Division.


Copyright © 2016 HealthDay. All rights reserved.

<< prev next >>