Case Result: Our Compliance Attorneys Working with Payors As Other Counsel’s Incorrect Advice on CPT Code Use Leads to Medicare, Insurer Audits

Professional:
Physician

Primary issue:
Client physician reached out to the healthcare compliance attorneys at Chapman Law Group, requesting a review of a set of CPT codes for a novel set of procedures the physician was to perform in the healthcare practice office. After a careful review of the CPT codes and the purpose for each, our healthcare compliance lawyers provided an opinion: three of the codes could not be used, while one code required very specific criteria for when it would be able to be used.

The physician did not favor our opinion and found a different attorney, who advised the physician that the one CPT code requiring specific criteria before being used, could be used without the specific criteria. A year later, the physician was on the verge of a federal indictment for using the code that the other lawyer said was usable, when it turned out the code could not be used for the physician’s intended purposes.

Benefits of Using Chapman Law Group:
In the course of 35 years, Chapman Law Group has built a reputation as a conservative health care law firm. Our health care lawyers perform thorough research for the correct answers before providing recommendations on all healthcare-related legal matters; if we say a particular CPT code cannot be used, we stand behind that answer. We strongly advise healthcare providers — whether physicians, chiropractors, pain management specialists, dentists, or other licensed healthcare professionals — to use caution when shopping around for lawyers’ opinions on healthcare compliance-related matters, and to stick with counsel that specializes solely in healthcare law.

Result:
Our health care compliance attorneys are now in the process of working with Medicare, third-party commercial insurers (Blue Cross Blue Shield and UnitedHealthcare), and other entities while massive audits are being performed on the physician’s practice for misusing the code in question.

The physician in this matter has since shared a positive opinion of the Chapman Law Group healthcare compliance practice group with several other doctors, who also have retained us for the same CPT code issues.

Areas of Law:
Healthcare Compliance

Disclaimer:
This information is a sample of our past results. Prospective clients may not obtain the same or similar results. Every case is different and each case must be evaluated and handled on its own merits. The circumstances of your case may differ from the results provided. The information provided has not been reviewed or approved by the State Bar.