AMA billing codes are new target in D.C.’s. war on health care fraud

WASHINGTON — For many years, the nation’s largest medical lobbying group has been held responsible by politicians for various issues within the healthcare system. Currently, it is facing a fresh wave of criticism as Republicans label their proposed healthcare budget cuts as measures to combat fraud. 

Under current law, physicians must use Current Procedural Terminology (CPT) codes to bill for services under Medicare and Medicaid. These codes, which describe the services a patient receives, are owned by the American Medical Association.

Rep. James Comer (Ky.), a prominent House Republican, has called for a meeting with officials from the Centers for Medicare and Medicaid Services. This meeting is intended to review the oversight of the CPT coding system as part of his committee’s ongoing investigation into fraud, waste, and abuse. In his letter, Comer points out that the “complexity” of medical coding “may be contributing to improper billing and higher costs,” creating an environment where billing errors are more likely.