Joseph Greenwald & Laake principal Brian Markovitz spoke to Matt Phifer at Bloomberg Law for an Aug. 21 story surrounding proposed medical payment code changes for Medicare and Medicaid office visits and outpatient services. Brian voiced concerns about these changes with regard to the False Claims Act and medical overbilling issues.
The article delved into the benefits and potential consequences of these changes, which would combine level two through level five evaluation management coding into one single level with one payment rate based on the frequency the code was used. Typically, payment coding is divided into five coding levels, and the more complex a patient’s office visit, the higher the code level they use. The Centers for Medicare and Medicaid Services believe that these changes will both improve the accuracy of payments and lessen administrative duties for doctors.
A common cause for False Claims Act litigation is upcoding, when doctors and medical professionals bill visits at a higher code than necessary for higher reimbursement. To Markovitz, these changes could potentially leave “a lot more room for malfeasance.”
“My concern would be it’s a way to potentially circumvent potential FCA claims because the consolidation of the codes would be bringing more services into one category,” Markovitz told Bloomberg Law.
Markovitz also said that combining categories could leave “a lot of room for overbilling issues.”
“If you’ve got multiple codes, you can use stats to show somebody is not coding properly. If you’ve got 50, 60, 70, 80 percent coming in at the top two tiers, that helps you establish that something is wrong.”
Brian Markovitz is a principal in JGL’s Labor and Employment and Civil Litigation practice groups, and focuses on helping victims who have suffered severe injustices in the workplace. He represents individuals in complex employment litigation and appellate matters involving wrongful termination, retaliation by employers in response to reporting fraud or misconduct and discrimination on the basis on race, gender, age and sexual orientation. Brian has won millions of dollars for his clients. For his continued excellence, Brian has been named one of America’s top 100 National Trial Lawyers.
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Reproduced with permission. Published Aug. 21, 2018. Copyright 2018 by The Bureau of National Affairs, Inc. (800-372-1033) <http://www.bna.com>