News Briefs: August 16, 2021

Targeted Probe and Educate (TPE) is back, CMS said in an Aug. 12 MLN Connects.[1] CMS is restarting TPE “to help educate providers and reduce future denials and appeals. If your Medicare Administrative Contractor audits you, take advantage of the TPE education, and get up to 3 rounds of educational claim review to help you bill accurately.” CMS has a TPE page on its website.[2]

Tri-County Hospitalists LLC (TCH), a physician-owned medical group, has agreed to pay $200,000 plus interest to resolve false claims allegations in connection with Medicare overbilling for advanced care planning (ACP) and tobacco cessation counseling (TCC) services, the US. Attorney’s Office for the Eastern District of Pennsylvania said Aug. 12.[3] TCH—which has offices in Philadelphia, Montgomery and Chester counties and provides services in hospitals, skilled rehabilitation facilities, outpatient practices and urgent care centers—allegedly pressured its personnel to bill Medicare for ACP and TCC services between January and September 2019 “regardless of medical need,” the U.S. attorney’s office said. “In most cases, the prerequisites for ACP and TCC services were not met and not every patient required the services that were billed. In some instances, TCH allegedly billed Medicare four or more times where ACP services were provided to a single patient over a short time frame with no evidence of any documented changes in patient condition to justify its billing activities” (e.g., billing for tobacco cessation counseling when patients didn’t use tobacco). TCH didn’t admit liability in the settlement.

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