Moderate sedation services allow patients to speak and breathe without assistance while relieving pain and anxiety during therapeutic and diagnostic procedures. Under New York Medicare requirements, moderate sedation services are only billable when physicians spend at least 16 minutes interacting with patients face-to-face.
After rejecting New York Spine and Wellness Center’s claims for the service in January 2015, a private insurance company performed an audit of the center in mid-2015. The audit allegedly revealed the center did not adhere to the 16-minute rule.
Following the audit, New York Spine and Wellness Center’s billing vendor advised the center to review the private insurer’s findings. However, investigators with the Attorney’s Office for the Northern District of New York claimed New York Spine and Wellness Center continued to improperly bill for moderate sedation services after mid-June 2015. The alleged improper billing reportedly stopped after investigators contacted New York Spine and Wellness Center.
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