Geico v. 567915
In Geico v. 567915 filed in 2017, Geico claimed that a billing issue was taking place. Geico claimed that every patient received a 99203 even though some patients had minor complaints of injuries and other patients had severe complaints of pain. The CPT Code 99203 recommended time is 30 minutes and numerous patients reported that the exam was no more than 15-20 minutes. Geico claimed that the Clinics were billing 99203 to obtain higher payments for the exam, although to be fair, if that were true the Clinics would have billed a level 4 or 5 code to obtain more money. Geico claims every initial report stated that the patient should treat everyday for the first two weeks and then three times per week. It is unclear whether that treatment plan was indefinite or whether Geico forgot to list the end date in the lawsuit.
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.