“According to the United States’ complaint, Vohra and Dr. Vohra knowingly engaged in a nationwide scheme to falsely bill Medicare for surgical debridement procedures to maximize revenue.”
The complaint alleges that the defendants pursued their fraudulent scheme in three primary ways. First, Vohra created a proprietary Electronic Medical Record (EMR) software that was programmed to bill debridements as surgical procedures even when they were not. Second, Vohra hired physicians without wound care expertise and provided training that omitted relevant Medicare payment rules and intentionally conflated the definitions of surgical and nonsurgical debridement procedures. Third, Vohra set corporate debridement targets based solely on revenue goals and pressured its physicians to meet those targets. As a result, Vohra allegedly caused the submission of claims for surgical debridement services that were not medically necessary and used billing codes that represented more complex procedures than were actually performed (commonly referred to as “upcoding”).
The complaint also alleges that the defendants programmed Vohra’s proprietary EMR software to improperly apply the Modifier 25 billing code and charge Medicare for exams that were not separately billable from surgical debridement procedures performed on the same day.”
The claims asserted in the government’s complaint are allegations only, and there has been no determination of liability.
Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/c/carolinefifemd/videos
The opinions, comments, and content expressed or implied in my statements are solely my own and do not necessarily reflect the position or views of Intellicure or any of the boards on which I serve.
