Category Archives: Healthcare

CPT Code 99072, Introduced for COVID-19, Finalized as Bundled Service by CMS

In a time when a trip to the nail salon requires a temperature check before entry, it comes as no surprise that medical providers across the globe have implemented extra protocols to keep physicians and their patients safe.  Since the start of the COVID-19 pandemic, medical providers have been forced to incur additional (and sometimes, substantial) costs associated with increased sanitization measures and personal protective equipment (PPE).

In an effort to alleviate COVID-19-related costs, the American Medical Association (AMA) created an additional supply code under CPT Code 99072, defined as: “Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when performed during a Public Health Emergency (PHE) as defined by law, due to respiratory-transmitted infectious disease.”[1] According to the Centers for Medicare & Medicaid Services (CMS),  the COVID-19 PHE was determined to exist nationwide as of January 27, 2020.[2]

Code 99072 became effective on September 8, 2020.  It is intended to be reported only once – per – encounter by a physician or other non-facility, only during a PHE, and only for “additional items required to support a safe in-person provision of evaluation, treatment, or procedural service(s),” which could include “the additional time required by clinical staff to provide the service safely.” [3]

Insurers and third-party payers can expect to receive reimbursement requests for 99072.  The AMA provided one clinical example of appropriate billing for 99072, as follows: “A 65-year-old female presents to the physician’s office, requiring care for an illness, acute injury, or ongoing care for a chronic condition. The encounter occurs during a Public Health Emergency (PHE), as defined by law, due to respiratory-transmitted infectious disease.”[4] The AMA CPT Assistant does not specify what documentation would be sufficient to substantiate reimbursement of 99072, but notes that the required documentation for reimbursement of 99072 will likely vary between third-party payers and individual insurers.

[1]           See American Medical Association (AMA) CPT Assistant, Special Edition September Update, (Vol. 30, Sept. 2020)

[2]           See Centers for Medicare & Medicaid Services (CMS), Health and Human Services (HHS), 2021 Medicare Payment Fee Schedule (MPFS) Final Rule, 85 FR 84472, 84692 (Dec. 28, 2020)

[3]           See American Medical Association (AMA) CPT Assistant, Special Edition September Update, (Vol. 30, Sept. 2020)

[4]           Id.


Filed under Healthcare, Personal Injury Protection (PIP)

Miami Chiropractor Charged With COVID Relief Fraud, Health Care Fraud And Money Laundering

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Filed under Fraud, Healthcare

10 Charged in $1 Billion Medical Insurance Fraud

Ten people have been indicted in a complex scheme to allegedly defraud private insurance companies of more than $1 billion for medical testing. The Justice Department unsealed the indictments Monday in Jacksonville, Florida. Eight of the defendants are from Florida. The others are from Atlanta and Chicago. The charges include conspiracy to commit health care fraud and money laundering.

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Filed under Fraud, Healthcare

NICB Launched Online COVID-19 Resource Center Due to Surge in Insurance Fraud Schemes

The National Insurance Crime Bureau (NICB) has created a new page on its website called the “NICB COVID-19 Resource Center.” The page provides the latest information on emerging fraud schemes due to an influx of insurance fraud cases tied to the COVID-19 outbreak.

The Coalition Against Insurance Fraud (CAIF) recently sent out a statement regarding a surge of fake coronavirus health coverage schemes. It warned that robocalls, text messages, and email phishing attacks could fake insurance deals to consumers, asking them to pay for health or travel insurance premiums without delivering coverage.

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Filed under Fraud, Healthcare

Boca Raton Doctor Charged with Insurance Fraud

A Boca Raton osteopathic physician Dr. Max Citrin has been charged with insurance fraud for allegedly copying and pasting false symptoms for his patients. Citrin was charged with three felonies for submitting fraudulent claims to Blue Cross Blue Shield, Cigna and Humana, totaling nearly 1 million dollars.

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Filed under Fraud, Healthcare

Tallahassee Doctor Accused of Billing Insurers for Phony Medical Procedures

Dr. Moses D. Degraft-Johnson of the Heart and Vascular Institute of Northern Florida in Tallahassee is accused of taking $26 million from health insurance agencies for phony medical procedures. According to federal prosecutors, Dr. Degraft-Johnson allegedly went to hospitals, scheduled patients for unnecessary visits, and billed for the services that never occurred. In some cases, the doctor was traveling when he claims to have done procedures in his office.

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Filed under Fraud, Healthcare

Weston Doctor Sentenced for Conspiring to Illegally Distribute Oxycodone

Dr. Rodolfo Gonzalez Garcia was sentenced to eight years in prison for conspiring to dispense oxycodone, a charge to which he had previously pled guilty. Dr. Gonzalez Garcia and his co-defendants, including his wife Arlene Gonzalez, admitted to using a Hialeah medical office to provide prescriptions for the controlled substance, even though he did not conduct meaningful examinations to prescribe oxycodone appropriately. Dr. Gonzalez Garcia referred to himself as “El Chapo of Oxycodone.”

Co-defendants Arlene Gonzalez and Annie Suarez-Gonzalez pled guilty to conspiracy to pay and receive health care kickbacks. They were sentenced to 4 months in prison and one year of probation each. Co-defendant Fidel Marrero-Castellanos pled guilty to conspiracy to pay and receive health care kickbacks and conspiracy to distribute controlled substances. He was sentenced to 13 months in prison. The co-defendants were ordered to pay a total of $26,306 in restitution.

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Filed under Fraud, Healthcare

Dozens Arrested in Medicare Fraud Crackdown in Miami

Miami police officers arrested at least 30 people on allegations of Medicare fraud. The scam involved people from four pharmacies who are facing three charges, including organized scheme to defraud. One of the pharmacies was paid over $5 million from federal funds for over 30,000 claims. Many of the claims were for medicines that were unnecessary and possibly never dispensed to patients. Included in the arrests were so-called “professional beneficiaries” — patients who allegedly allowed their Medicare benefits to be used for the scam in exchange for kickbacks.


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Filed under Fraud, Healthcare

Unlicensed Florida Doctor Arrested For Unlicensed Medical Treatments and Fraudulent Billing

Ozioma Maduka of Osceola Injury Center, LLC was arrested for allegedly practicing healthcare without an active, valid Florida medical doctor’s license as well as fraudulently billing unlicensed medical treatments. Maduka billed two insurance companies for more than $4,400 in claims for unlicensed treatment of auto accident victims.

Maduka could face up to 5 years in prison if convicted.

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Filed under Fraud, Healthcare

Three South Floridians Arrested in Sober Home Health Care Fraud Scheme

Peter Port, 64, of Boca Raton; Brian Dublynn, 62, of Fort Lauderdale; and Jennifer Sanford, 57, Hollywood were arrested for allegedly billing health-insurance companies for services that were not performed or medically necessary. Port, Dublynn and Sanford made about $13 million in the scam through Safe Haven Recovery, a substance abuse treatment facility in Miami.

The trio was charged with conspiracy to commit health care fraud and wire fraud, health care fraud, conspiracy to commit money laundering and money laundering. They could face at least 20 years in prison if convicted.

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Filed under Fraud, Healthcare