Geico v. 567156
In Geico v. 567156 filed in 2021, Geico claimed that the pain management doctor was performing Radio Frequency Ablations on patients within 4-8 weeks of the car accident and that the patient could not have failed conservative treatment in that time frame. Geico also stated that the provider was billing $655 for CPT code 72275 (Diagnostic Radiology Procedures of the Spine) whenever they billed/performed a medial branch block but the provider never prepared a formal written report of the findings and never maintained the images of documenting the flow of contrast in the patient. Also, the provider was billing $1,500 for 77003 (fluoroscopic guidance) whenever they performed an injection which is included in the procedure and considered this “unbundling” of codes.
The provider also billed $100 for 98960 (education and training) while billing for examination codes which is unbundling. This “education and training” is supposed to be performed by a nonphysician healthcare professional; however, the medical doctor was the person who performed the services. The provider was billing “virtually” every patient about $800 for a 99204 examination. The provider was billing 95851 for range of motion testing while he was already billing a 99204 examination and it should have been included in 99204.
DISCLAIMER
This is based on a real court case that was previously filed against a medical provider/doctor. The case number has been partially redacted and names have been changed to protect the Defendants’ names. This example is posted to help educate others on the laws and potential pitfalls. This posting is not intended to embarrass or defame anyone. I have limited the information and simplified some of the facts in the lawsuit to reflect key points and make a complicated case easier to understand. This “example” is directly from a complaint filed by an insurance company, therefore, I am using the facts THEY presented. There are always two sides to a story so please understand this is just one side of the story. This information was found through records available to the public.