It is nothing in this situation - Be careful Posted: Feb 18th, 2016 - 8:06 am In Reply to: If the examination is falsified, the billing IS fraudulent. - I do know a bit about this.
Unless this provider is doing this intentionally to bilk Medicare or ordering additional tests based on the dictation, then it is not fraud. Miotic pupils is not a billable diagnosis. Think of all the boiler plate physical exams. I am familiar with one provider who dictates the same respiratory rate for every single patient, is that fraud? We all know that exams get dictated that may not be 100% accurate. If it doesn't affect the diagnosis or the way the encounter is billed it is not fraud and it has nothing to do with a provider's ethnic background.
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