A new, outside audit of Scottsdale Physicians Group found evidence suggesting upcoding, billing for medically unnecessary services, and cloning health records. MORE ⬇️
The independent billing expert concluded in her report if the federal government were to do its own audit"it is probable that more than 90% of payments from Medicare...would have to be repaid."The hospitalist group provided care inside HonorHealth Shea Medical Center since at least 2016. SPG, SPG Hospice, and United Telehealth are all now in bankruptcy court.
The SPG bankruptcy trustee, currently overseeing the company, paid for — and recently shared with the court — an independent billing audit. But other reports documented that on all 10 days, the patient was"moaning and stating her ‘tailbone’ hurts.” ABC15 had Arrigo look at the independent audit and the DOJ's $589 million claim, which alleged the company submitted false and upcoded claims to get millions more in Medicare reimbursement.In addition to the copy-and-pasted medical records known as 'cloning,' the independent auditor, who has more than 20 years of experience, found billing irregularities.
The auditor went on to say SPG’s Documentation “did not substantiate the medical necessity of the level reported to Medicare for 89% of the encounters.” "Unfortunately, medical billing is complex enough that it's not often discovered to be improper or fraudulent without a whistleblower," said Arrigo.
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