North Carolina Federal Judge Partially Upholds Downcoding Of Services

North Carolina Federal Judge Partially Upholds Downcoding Of Services

RALEIGH, N.C. - A federal judge in North Carolina on May 29 partially granted and partially denied a motion for summary judgment seeking a reversal of a final Medicare reimbursement decision by U.S. Health and Human Services Secretary Kathleen Sebelius, finding that Sebelius' decision to deny reimbursement for some evaluation and management (E/M) services was not arbitrary or capricious. The judge, however, found that claims for at least one beneficiary should have been paid using the standards HHS uses for evaluating claims (Ibikunle Ojebuoboh, M.D., v. Kathleen Sebelius, No. 4:11cv00017, E.D. N.C., Eastern Div.; 2012 U.S. Dist. LEXIS 73821).

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