December 2, 2013

162017_132140396847214_292624_nOn August 27, 2013, the CEO of Mobile Doctors was charged with fraudulently increasing Medicare bills for in-home patient visits by falsely claiming that the visits were longer and more complicated than they actually were. Mobile Doctors is a Chicago-based company that manages physicians in six states who make house calls for patients. Mobile Doctors arranges the home visits and has contracts with the physicians who perform them. The physicians are paid directly by Mobile Doctors – the physicians assign their rights to bill and collect payments for their services to Mobile Doctors, which then files claims for reimbursement with various federal health care programs, including Medicare. Mobile Doctors’ main office is in Chicago and it has satellite offices in Detroit, Flint, San Antonio, Austin, Kansas City, Phoenix, and St. Louis.

The alleged fraudulent scheme involved what is called upcoding. Medicare and other federal health care programs reimburse physicians and other health care providers based on the amount of time and the complexity of the care provided. The less time and the less complexity involved with the services and visits, the less the amount of reimbursement. Upcoding involves billing at a higher code than should be billed.

There are four Medicare billing codes established for house calls for established patients, ranging from $54.44 for visits that typically last 15 minutes to $173.52 for more complex visits that last 60 minutes. The two middle billing codes reimburse $82.34 for 25 minutes and $124.86 for 40 minutes, respectively.

According to an investigation involving Mobile Doctors, a typical home visit performed by Mobile Doctors physicians was routine and lasted between 10 and 30 minutes. However, about 99% of the claims submitted to Medicare by Mobile Doctors from 2006 through February 2013 were billed using the highest two codes, indicating moderate to high complexity medical decision-making and detailed to comprehensive interval histories or medical examinations lasting at least 40 minutes. From 2006 through 2012, Mobile Doctors received approximately $21.4 million in payments from Medicare on claims using the second-highest code and approximately $12.6 million in Medicare payments on claims using the highest fee code.

The federal charges further allege that physicians working for Mobile Doctors falsely certified patients as confined to their homes and requiring home health services when they were not home-bound and did not require such care. Mobile Doctors benefited because its physicians received more referrals from the agencies that provided home health services. One particular Mobile Doctors physician was allegedly named as the referring physician by more than 200 home health agencies that submitted Medicare claims for services between August 2010 and July 2013, resulting in more than $10 million in Medicare payments.

Between January 2006 and March 2013, Mobile Doctors physicians certified or recertified for 60-day periods approximately 15,598 patients as confined to their homes and requiring home health services a total of approximately 83,133 times, many of which were allegedly false. Approximately 6,057 of these certifications since August 2007 were attributed to the same Mobile Doctors physician referenced above, for which Mobile Doctors billed Medicare for approximately 17,439 patient visits the same physician made during that time. The physician was charged with fraud along with the CEO of Mobile Doctors.

Mobile Doctors claims that it physicians have made over 500,000 home visits since it began operations.


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