False Claims Charges Can Have Heavy Financial Consequences Whether You’re Guilty or Not

Urgent care operators as a whole put considerable attention on ensuring that their coding and claims procedures are pristine. It’s not just a matter of economic survival through ensuring the practice gets the reimbursements they deserve, but also an existential imperative; practices that fail to demonstrate due diligence in seeking that reimbursement face potentially catastrophic financial consequence. Even the appearance of noncompliance with proper procedures can raise red flags and sink a perfectly healthy operation. For evidence, look no further than the $1.6 million an urgent care operator in Georgia agreed to pay to settle allegations that it violated the False Claims Act by submitting miscoded Evaluation and Management claims for Medicare related to testing and treating patients possibly exposed to COVID-19 during the pandemic. Pay close attention to that previous sentence; the settlement is in response to the allegations of impropriety and does not reflect guilt or innocence. As the U.S. Attorney’s office noted in its announcement of the settlement, “The claims resolved by the settlement are allegations only, and there has been no determination of liability.” The baseline has to be familiarity with current E/M coding. Read What’s New in Coding for 2023? in the JUCM archive to get a sense of how you’re doing in that area.