E/M coding without proper documentation will get you in trouble

On July 3, 2013, the United States Department of Justice announced Sound Inpatient Physicians, Inc. (“Sound Inpatient”) will pay $14.5 million dollars to settle allegations that it over-billed Medicare and other federal health care programs. The Washington-based company employs more than 700 hospitalists and post-acute physicians to facilities in twenty-two states.

Under the whistleblower provisions of the False Claims Act (“Act”), a former Sound Inpatient regional manager alleged the company was submitting evaluation and management (“E/M”) claims for reimbursement that were unsupported by medical documentation. The government then intervened; no surprise, considering that since January 2009, the Justice Department has recovered a total of more than $14.7 billion through False Claims Act cases.

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