By Christopher A. Parrella, Esq., CPC, CPCO, CHC, Healthcare Attorney

Monday, September 18, 2023

The landscape of medical billing and compliance is ever-evolving, with the responsibility to adhere to guidelines and regulations squarely on the shoulders of practitioners and consultants. The recent announcement from the U.S. Attorney’s Office in the Southern District of Texas illustrates the importance of this responsibility and the consequences of perceived non-compliance.

Settlement Overview
Franceene McKinney, a Cincinnati-based healthcare consultant specializing in medical IT and coding, recently agreed to a settlement of $30,000 following allegations of her involvement in causing the submission of fraudulent Medicare claims. Through her company, IOS Consultants LLC, McKinney provided expertise to a broad spectrum of medical professionals, extending from the Cincinnati region to the Southern District of Texas.

The allegations focus on a period between Jan. 1, 2016, to Dec. 31, 2020, wherein McKinney allegedly directed providers to a specific Medicare billing code reserved for the surgical implantation of neurostimulator electrodes. These procedures, usually conducted in an operating room, garner thousands of dollars from Medicare due to their invasive nature.

However, in stark contrast, the services that McKinney’s clients purportedly provided were non-surgical. Patients were given devices meant for electro-acupuncture—a far less invasive procedure involving mere needle insertions into the ears and attaching a neurostimulator with adhesive.

Consequences Beyond Financial Settlement
In addition to the pecuniary aspects of the settlement, both McKinney and IOS Consultants LLC have been excluded from participating in federal health care programs for a duration of three years. This penalty underscores the gravity of the allegations and the potential implications for professionals found in non-compliance.

The case involving McKinney is not an isolated incident. It marks the tenth such case resolved by the Southern District of Texas, with prior cases encompassing settlements with diverse medical professionals, from anesthesiologists to podiatrists.

Conclusion and Reflection
It’s imperative to mention that the claims being settled are, at this point, allegations. There’s been no formal determination of liability. Nevertheless, the case serves as a poignant reminder for professionals in the healthcare sector. The importance of adhering to billing codes, ensuring proper training, and constantly updating oneself on guidelines cannot be overstated.

These cases, while unfortunate, are essential in maintaining the integrity of our healthcare system. As professionals in the industry, continuous diligence, and adherence to ethical standards are paramount. The onus remains on both individual consultants and medical practitioners to ensure that guidelines are followed meticulously, mitigating risks and upholding the trust bestowed upon them by patients and the broader community.

Disclaimer: The information provided in this blog post does not constitute legal advice. Healthcare providers should consult with a healthcare compliance attorney for advice on their unique circumstances.