Doctors Pay for Unsupported Diagnoses to MA Program

Complete Physician Services (CPS) and doctors Kenneth Wiseman and Steven Schmidt agreed to pay $1.5 million to resolve False Claims Act allegations that they caused the submission of false claims by misrepresenting the severity of illness and services rendered to increase reimbursement from the Medicare Part C (Medicare Advantage, or MA) and Part B programs. The government alleges that CPS submitted morbid obesity diagnosis codes to Part C where the diagnoses lacked medical support. Also alleged is that CPS’ submission of chronic obstructive pulmonary disease (COPD) diagnoses were not medically supported or supported by appropriate medical documentation in many instances. Read a Department of Justice press release.

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