WISCONSIN BC-BS GETS THEIR MAN – Upcoding Doc Goes Down

Copyright held by The John Cooke Fraud Report. Reprint rights are granted with attribution to The John Cooke Fraud Report with a link to this website.

It was Code 90844 that heavily figured in the guilty verdict. To bill this level of service, a psychiatric patient must be seen for approximately 40-50 minutes by the doctor or by a qualified therapist supervised by the doctor. Allan Belden employed RNs and it was these RNs who did the patient follow-up visits in many (if not most) cases. Investigators found that Belden was sometimes out of the country during these visits.

 One of the requirements for a guilty finding was to ascertain that the accused doctor was not innocently erring due to reasonable confusion with the billing codes. Prosecutors were able to show that Belden did not allow the RNs to sign their own progress notes, allegedly in an attempt to indicate that he was personally providing or directly supervising the patient visits. They also showed that appointments were routinely blocked for 30 minutes, sometimes lasted less than that, and were still billed at the higher codes.

© 2000 John Cooke Fraud Report