A Philadelphia-based physician practice and two physicians agreed to pay $1.5 million plus interest to settle allegations they misrepresented the severity of illness and services rendered to increase Medicare Advantage and Medicare Part B reimbursements.
Complete Physician Services, Kenneth Wiseman, DO, and Steven Schmidt, DO, allegedly submitted morbid obesity diagnosis codes to Medicare Advantage for patients with a body mass index under 35, according to a May 25 Justice Department news release. The Justice Department also alleged the physicians submitted chronic obstructive pulmonary disease diagnoses that were not medically supported.
Complete Physician Services also allegedly improperly billed Medicare Part B for physician services that occurred on occasions when the physician was out of the country, according to the news release. They also allegedly submitted unsupported claims for smoking cessation counseling, pulmonary function tests and vaccine administration.
The alleged improper billing occurred between Jan 1, 2015 and Dec. 31, 2018, according to the release.