The medical billing factoring and medical coding invoice funding specialists at PRN Funding came across an interesting article that we believe is important to share with our Medical Billing and Medical Coding readers. We summarized the article below. You can read the article in its entirety on HealthLeadersMedia.com, Ca Medical Biller to Pay $4.6M to Settle Fraud Allegations.
Federal prosecutors alleged that Janzen, Johnston & Rockwell Emergency Medicine Management Services Inc. inflated claims that it had coded on behalf of emergency room physicians in Louisiana and California, and as a result of the fraud allegations, JJ&R agreed to pay the federal government $4.6 million.
From approximately 2000 through 2007, JJ&R used a coding formula that tended to generate claims for a marginally higher level of evaluation and management service than physicians had actually provided. In addition, JJ&R allegedly often failed to comply with Medicare’s coding rules governing claims for teaching physicians, resulting in claims that were not properly payable.