Dr. Wendy Kurtz, is an ear, nose and throat specialist (ENT) in Portland Oregon. Dr. Kurtz provides ENT services locally to patients in her community through NosesRus, P.C. (NRU). Dr. Kurtz is one of six physicians in the practice, and all of the physicians are shareholders in NRU. Earlier this year, the NRU’s compliance officer, Ms. Stevie Budd, gave a presentation to all employees, including department directors, and senior managers on proper Medicare billing practices for ENT services. This included the fact that to bill Medicare for sinus surgeries, there must be documentation in the medical record to support the services are “medically necessary”. A few weeks ago, while visiting with the clinic’s the nursing department, Ronnie Lee, a nurse manager tells Stevie that Dr. Kurtz is performing medically unnecessary services on her patients. Additionally, Ronnie states that NRU has submitted bills to Medicare and received payment. Ronnie Lee cites examples of patients that underwent sinus surgeries without an initial throat exam or other imaging studies, such as a head CT, to support medical necessity. Upon hearing this information, Stevie realizes that she may need to conduct an investigation and brief the compliance committee on this particular concern raised.
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