George B. Breen, Member of the Firm in the Health Care and Life Sciences and Litigation practices and Chair of the firm’s National Health Care and Life Sciences Practice Steering Committee, was quoted by Bloomberg BNA, in “Increased Enforcement Likely Due to ICD-10, Attorney Says.”
Following is an excerpt:
Since ICD-10 codes are far more specific than the current ICD-9 codes for health-care claims, providers will have to maintain documentation supporting all of their claims and can expect to face aggressive audits questioning the medical necessity of the claims, George Breen, an attorney with Epstein, Becker & Green PC, Washington, said during a Bloomberg BNA-sponsored event.
“Medicare only pays for services that are reasonable and necessary, and ICD-10 codes will be used to see if that standard is being met,” Breen said.
Correct use of ICD-10 codes is especially important, Breen said, since a claim with an incorrect ICD-10 code could be considered a false claim and therefore a violation of the FCA.
A specific intent to submit a false claim is not necessary to violate the FCA, and liability exists for those who submit the claim as well as those who cause false claims to be submitted, Breen said.
The article reviews a presentation Mr. Breen gave on
how the health care industry is preparing to transition to the International Classification of Diseases, 10th Revision (ICD-10), an update to the coding system used to diagnose and treat patients.