UROLOGY PRACTICE SUBMITS INFLATED CLAIMS TO THE GOVERNMENT

Several Whistleblower Partners attorneys represented a whistleblower in a qui tam lawsuit alleging that a large urology practice fraudulently and systematically miscoded its services to increase reimbursements from insurers, including Medicare and private insurers in California. The relevant code, modifier 25, applies when a physician performs an evaluation and management service and a separate and distinct service on the same day. Improperly billing modifier 25 when no distinct service occurs–called “unbundling fraud”–can inflate reimbursement. To resolve the case, Skyline Urology paid the United States $1.85 million and California $250,000. The whistleblower received over $300,000 as an award. See Department of Justice.