Some evidentiary considerations for physician billing

In a criminal prosecution for medical billing fraud alleging up-coding and overbilling, the government's evidence may encompass the practice's entire billings and draw inferences from them. In addition, fraud may be demonstrated through statistical analysis comparing a physician's billings relative to other providers of the same specialty. The Federal Rules of Evidence govern the admissibility of evidence during a trial, to provide fairness for both the prosecution and the defense. Physicians and practice managers should be well versed in the billing requirements and particularly careful when CPT codes are expressed in terms of "required times" as opposed to "typical times."