Internal Auditor Turns Whistleblower at Cardiology Practice

Author: Jaun Paul

Author: Jaun Paul

A Michigan cardiology practice had ignored the concerns about evaluation & management upcoding of an internal auditor, Wendy Domke. She turned whistleblower and a $669,413 settlement with the Department of Justice.

An internal auditor turned whistleblower when she felt a Michigan cardiology practice was ignoring her concerns about evaluation & management upcoding. A $669,413 settlement with the Department of Justice is the end result.

According to a press release, Genesys Health Systems in Grand Blanc, MI paid $669,413 to settle a lawsuit alleging the provider violated the FCA by improperly upcoding E/M services provided to cardiology patients.

A recent article in The Flint Journal sheds some light on why Wendy Domke decided to blow the whistle on Genesys. While working in 2006 as an internal auditor for Catholic Healthcare Audit Network (owned by the same company as Genesys), Domke spotted what she thought were problematic coding patterns for three cardiologists.

Heres the history why Domke decided to lash out at Genesys. In 2006, while working as an internal auditor for Catholic Healthcare Audit Network (owned by the same company as Genesys), Domke found out what she thought were problematic coding patterns for three cardiologists.

When she raised the issue with the upper management of Genesys, she did a lot of soul searching. According to her, Theres a line overbilling as a mistake and overbilling where there appears to be a pattern; in this care there appeared to be a pattern.

Genesys statement called the alleged overbilling inadvertent documentation, and billing errors and the company does not admit liability.

Domke now works as an independent consultant as she had left her auditing position with Catholic Healthcare.

About the Author:

Provides weekly digest newswire about healthcare compliance, and offers advanced Learning Opportunities about false claims acts for healthcare executives and physician billers according to Medicare compliance plan.

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