In this episode of Deeper Than the Headlines, CJ Wolf walks us through the details behind a headline that’s making waves: A Minnesota couple indicted in connection with allegations around a $15 million medical billing fraud case. At first glance, it might seem like another fraud story—but a deeper look reveals important nuances about compliance, coding, and documentation.
According to court records, the indictment focuses on improper use of CPT® codes related to biofeedback, neurofeedback, and neurobehavioral testing. While neurofeedback and biofeedback may sound similar, they are distinct procedures with different coding requirements. It’s alleged that neurofeedback services were billed using a code intended for biofeedback—potentially to obtain reimbursement that neurofeedback might not have received.
The case also alleges billing overlapping codes along with allegations of using modifiers to bypass coding edits designed to prevent double billing.
No guilt has been established because this is an indictment, not a conviction. But the case is a compelling reminder of why certified coders, auditors, and strong compliance oversight are critical.
Cases like this illustrate the real-world implications of coding missteps. Whether intentional or not, inaccuracies in billing can lead to serious consequences. For compliance professionals, this episode serves as a practical example of why detail, documentation, and ethics matter.
CJ Wolf
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