Miramar, Fla.-based Vohra Wound Physicians Management and its founder Ameet Vohra, MD, are facing a federal complaint alleging a Medicare fraud scheme involving overbilling and unnecessary wound care services provided to nursing home patients, according to an April 4 news release from the Justice Department.
What happened?
- The complaint alleges Vohra’s software auto-coded wound care as surgical debridements, even when they were nonsurgical. Additionally, physicians were allegedly hired without wound care experience, trained without clarity on Medicare billing rules and pressured to meet targets based on revenue rather than medical necessity.
- The complaint alleges the software automatically added Modifier 25 to bill Medicare for evaluation and management services that were not separately billable.
- According to a news release from the wound care group, Vohra claims to have been cooperating with the government since receiving a subpoena in 2018, and has repeatedly sought feedback to adjust billing practices.
- Vohra says the case hinges on ambiguous distinctions in Medicare coding between selective versus surgical debridement. Additionally, it said its physicians exercised independent clinical judgment, not following a corporate mandate to overbill.
What happens next?
- While open to resolution, Vohra said it will defend itself, if needed, to avoid prolonged litigation.
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