Azomani v. State — Aug. 2016 (Summary)

FRAUD AND ABUSE

Azomani v. State
No. 2015–KA–00050–COA (Miss. Ct. App. Aug. 9, 2016)

The Court of Appeals of Mississippi affirmed a jury’s verdict finding a physician guilty of Medicaid fraud.

A physician used the incorrect CPT Code, 99215, to bill Medicaid for services rendered to 125 children, resulting in him receiving the maximum payment for those services.  The Medicaid Fraud Control Unit investigated the physician’s billing practices, and found that the services were improperly billed to Medicaid.  The physician was indicted, found guilty of fraudulently misusing Medicaid billing codes, and he appealed arguing, among other things, that there was no evidence that he intended to improperly bill Medicaid.

The physician argued that he relied on the results of an audit by the Mississippi Department of Medicaid, which reported three coding errors, but none related to 99215, and that his reliance shows that there is no evidence that he “willfully, unlawfully, and feloniously” filed fraudulent claims for Medicaid benefits.  The appeals court focused on the testimony of the Program Integrity Director of the Mississippi Department of Medicaid, who stated that the physician was ultimately responsible for submitting properly coded bills, and that viewed in the light most favorable to the state, a jury could have found that the physician was ultimately responsible, regardless of the errors in the audit, and affirmed the conviction.