In conjunction with its representation of several health care providers across the country, Oberheiden, P.C. encountered a recurring issue of providers being forced to defend against multiple independently-conducted investigations related to their P-Stim and ETPS billings under Medicare. Typically, providers would first be contacted by the Centers for Medicare and Medicaid Services (CMS) about potential recoupment liability; and, while attempting to resolve any issues with CMS, these providers would then be contacted by the DOJ, the U.S. Attorney's Office, and/or the U.S. Department of Health and Human Services' (DHHS) Office of Inspector General (OIG) regarding the same alleged billing violations.
This lack of coordination presented unnecessary burdens for health care providers, and it also resulted in unnecessary duplication of efforts by the federal authorities involved. As a result, Oberheiden, P.C. recommended that the DOJ undertake efforts to streamline federal P-Stim Medicare fraud investigations. "We are continuing to see a high volume of False Claims Act investigations targeting health care providers' purchase and use of P-Stim devices," said Dr. Oberheiden, founding attorney. "We are pleased with the DOJ's decision to appoint a national coordinator, as this will streamline the process of resolving these investigations for all parties involved."
According to Dr. Oberheiden, health care providers' Medicare billings for P-Stim devices and related ETPS services have recently been the subject of intense federal scrutiny. In particular, he says, CMS, the DOJ, the OIG, and the U.S. Attorneys' Office are targeting providers' use of HCPCS Code L8679 and CPT Code 64555. In some cases, providers are also facing allegations of improperly applying Modifier 25 to Code L8679, which CMS states should only be used in cases where a patient receives a "significant, separately identifiable E/M service" in connection with the implantation of a qualifying medical device.
While coordinating the federal government's efforts to recoup improper Medicare billings for P-Stim devices and related ETPS services will streamline the investigative process, Dr. Oberheiden cautions that this does not mean the providers targeted in these investigations are less at risk. "The federal government tends to focus on cases in which the recoupment potential is substantial," he says. "As a result, health care providers that bill Medicare for P-Stim devices and related services should carefully review their billing policies, and those that are targeted in False Claims Act investigations should seek legal representation immediately."
The information contained in this statement does not constitute legal advice. Prior results do not guarantee similar outcomes. This information may constitute attorney advertising in some jurisdictions. All website disclaimers apply.