Healthcare Inspection Review of Allegations of Coding and Billing Irregularities, VA Medical Center, Kansas City, Missouri

This report reviewed allegations regarding a pattern of inappropriate medical coding and billing to increase third party insurance reimbursements at the Kansas City VA Medical Center. The allegation included two specific incidents: (1) the Medical Care Collection Fund Billing Department inappropriately added a Current Procedural Terminology “modifier 59” to the billing records for a patient receiving “Epoetin” injections, (2) and the Billing Department inappropriately billed for complications attributable to the patient’s participation in a voluntary research study. We were unable to substantiate the allegations and make no recommendations.