another govt enforcement

[MSmentor018]

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got an email blast, guess the meditrons have to write their own notes now

The article this link takes you to describes a Louisville, Kentucky home health provider who agreed to pay a $3.3 million fine to the federal government to settle a False Claims Act allegation. Copy and paste is not a recommended action when writing notes into a medical record. Until now, the federal government/Department of Justice (DOJ) have not focused prosecution upon the cut and paste practice, though they have been putting out bulletins intended to warn all physicians/providers that this type of action was coming.

http://www.fiercehealthcare.com/it/don-t-let-your-cut-copy-and-paste-use-land-you-fca-hot-water

It is now clear that the Office of the Inspector General (OIG) and the DOJ are serious about prosecuting this type of activity and that they see this practice as potentially criminal in nature. It is in everyone’s best interest to minimize/eliminate cut and paste as quickly as possible to reduce the risk of finding yourselves in this predicament.

 

[Xerxes1729]

Take a look at what they actually did. According to the DOJ:

• MD2U required non-physician providers (NPPs) to document that patients were homebound or home-limited and indicate in the medical record that an outpatient visit would jeopardize the patient’s health, regardless as to whether this was true or not. A number of MD2U patients were neither homebound nor home-limited, as some patients worked outside the home, attended school outside the home, drove independently, routinely saw other providers in the office and in at least one case, went horseback riding.
• MD2U would require NPPs to perform medically unnecessary visits and improperly bill Government Health Care Programs for evaluation and management (E&M) visits in order to generate revenue. Management instructed NPPs to schedule patient visits more frequently than necessary in order to increase productivity.
• According to a review of Medicare claims submitted by MD2U between July 1, 2007, and Nov. 30, 2014, 98 percent were falsely billed to Medicare. NPPs’ patient visits would often last less than ten minutes with some lasting less than five minutes (and in at least one reviewed case – 34 seconds), but these encounters were billed as comprehensive medical visits and billed at the highest level E&M code possible. The American Medical Association’s guidelines for these codes indicate that practitioner’s using the codes billed by MD2U should be performing comprehensive medical exams and should typically spend 60 minutes face-to-face with the patient, family member or caregiver.
• Management trained NPPs to bill all visits using the highest level E&M code available.
• MD2U also utilized an electronic medical records (EMR) system that permitted the NPPs to easily electronically cut, copy and paste medical notes from prior visits. The ability to migrate notes from visits that occurred weeks, months, or even years prior to the current patient encounter created the illusion that MD2U’s NPPs were performing a significant amount of work during their patient encounters when, in fact, they were not. If the documentation was deficient to bill the highest level code, MD2U would direct NPPs to go back and change the medical record – after the encounter had occurred – to falsely show that more work was performed during the visit in order to support the highest level billing.

Is there anyone that really thinks this isn't fraud? They got fined millions of dollars not because the copied and pasted a med list or a PMH but because they lied about whether patients were actually homebound, performed unnecessary services, upcoded visits, and altered records after-the-fact to support higher levels of billing. Part of the scheme was copying and pasting records, but it wasn't the crux of the violation.

 

[MSmentor018]

wow. and they've got a huge pt population here in FL

 

[gutonc]

Take a look at what they actually did. According to the DOJ:

• MD2U required non-physician providers (NPPs) to document that patients were homebound or home-limited and indicate in the medical record that an outpatient visit would jeopardize the patient’s health, regardless as to whether this was true or not. A number of MD2U patients were neither homebound nor home-limited, as some patients worked outside the home, attended school outside the home, drove independently, routinely saw other providers in the office and in at least one case, went horseback riding.
• MD2U would require NPPs to perform medically unnecessary visits and improperly bill Government Health Care Programs for evaluation and management (E&M) visits in order to generate revenue. Management instructed NPPs to schedule patient visits more frequently than necessary in order to increase productivity.
• According to a review of Medicare claims submitted by MD2U between July 1, 2007, and Nov. 30, 2014, 98 percent were falsely billed to Medicare. NPPs’ patient visits would often last less than ten minutes with some lasting less than five minutes (and in at least one reviewed case – 34 seconds), but these encounters were billed as comprehensive medical visits and billed at the highest level E&M code possible. The American Medical Association’s guidelines for these codes indicate that practitioner’s using the codes billed by MD2U should be performing comprehensive medical exams and should typically spend 60 minutes face-to-face with the patient, family member or caregiver.
• Management trained NPPs to bill all visits using the highest level E&M code available.
• MD2U also utilized an electronic medical records (EMR) system that permitted the NPPs to easily electronically cut, copy and paste medical notes from prior visits. The ability to migrate notes from visits that occurred weeks, months, or even years prior to the current patient encounter created the illusion that MD2U’s NPPs were performing a significant amount of work during their patient encounters when, in fact, they were not. If the documentation was deficient to bill the highest level code, MD2U would direct NPPs to go back and change the medical record – after the encounter had occurred – to falsely show that more work was performed during the visit in order to support the highest level billing.

Is there anyone that really thinks this isn't fraud? They got fined millions of dollars not because the copied and pasted a med list or a PMH but because they lied about whether patients were actually homebound, performed unnecessary services, upcoded visits, and altered records after-the-fact to support higher levels of billing. Part of the scheme was copying and pasting records, but it wasn't the crux of the violation.

But...but...the gummint is bad. Don't you know anything?