Provider Pays $14.9M in FCA Settlement Over CCM, Another E/M Code

By Nina Youngstrom

In possibly the first false claims settlement over chronic care management (CCM), Bluestone Physician Services of Florida LLC, Bluestone Physician Services, P.A. and Bluestone National LLC agreed to pay $14.9 million to settle allegations they billed for evaluation and management (E/M) services for chronic care patients that didn’t comply with Medicare, Medicaid and TRICARE requirements, the U.S. Department of Justice (DOJ) said June 5.[1] The services were provided in assisted living and other care facilities.

The False Claims Act (FCA) lawsuit was set in motion by a whistleblower, Lisa Loscalzo, the former general manager for Bluestone’s Florida market. According to the settlement, DOJ and the states of Florida and Minnesota alleged Bluestone submitted claims for the domiciliary rest home visit code for established patients (CPT 99337) and for the CCM code (CPT 99490) from January 1, 2015, through December 31, 2019, that didn’t satisfy the requirements of the three federal health care programs.[2] The claims for the E/M codes allegedly didn’t support the level of services provided.

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