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June 10, 2024

Compliance Case

The new coding assistant at the Gordon Medical Group office coded and submitted a claim to Cigna for an initial evaluation and management office visit. However, the patient was established with the practice and was seen only for a follow-up medical check. The employee who submitted the claim is new, but has submitted similar claims on several occasions.

As the Manager, discuss how you would address this issue. For instance, was it an honest error, additional education or training needed, or an act of fraud and abuse?

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