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  • Writer's pictureJames A. Gustino

$14,902,000 Paid to Settle False Claims Act "Upcoding" Case

This "upcoding" phenomenon, i.e., submitting bills for Medicare/Medicaid reimbursements that claim more extensive services were provided than actually were provided, is a long-time favorite of medical fraudsters. Fortunately, in this instance, the fraud was exposed and taxpayer moneys recovered.

//Bluestone Physician Services of Florida LLC, Bluestone Physician Services, P.A. and Bluestone National LLC, operating in Florida, Minnesota and Wisconsin, respectively, have agreed to pay $14,902,000 to resolve allegations that they knowingly submitted claims for certain Evaluation and Management (E&M) codes for services related to the management of chronic care patients in assisted living and other care facilities that were not provided in conformity with applicable Medicare, Medicaid and TRICARE requirements. 


The settlement resolves allegations that, during the period from Jan. 1, 2015, through Dec. 31, 2019, Bluestone knowingly submitted claims for two E&M codes, the domiciliary rest home visit code for established patients (99337) and the chronic care management code (99490), that did not support the level of service provided.//

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