Republican Lawmaker Targets AMA Billing Codes in Healthcare Fraud Investigation

House oversight committee Chair Rep. James Comer (R-Ky.) is requesting a meeting with Centers for Medicare and Medicaid Services officials to discuss oversight of the Current Procedural Terminology (CPT) coding system, which is owned by the American Medical Association. Comer suggests the complexity of CPT codes, which federal law requires doctors to use for Medicare and Medicaid billing, may contribute to improper billing and fraud.

Comer fraud investigation

• ▪Rep. James Comer (R-Ky.) suggests the complexity of medical coding may be contributing to improper billing and higher costs.
• ▪Rep. James Comer (R-Ky.) is the chair of the House oversight committee.
• ▪Rep. James Comer (R-Ky.) is requesting a meeting with Centers for Medicare and Medicaid Services officials to discuss their oversight of the CPT coding system as part of his committee's investigation into fraud, waste, and abuse.
• ▪Rep. James Comer (R-Ky.) suggests the complexity of medical coding creates an environment where billing inaccuracies can flourish.

CPT coding system

• ▪Current Procedural Terminology (CPT) codes describe what services a patient received.
• ▪The law requires that doctors bill for services in Medicare and Medicaid using Current Procedural Terminology (CPT) codes.

AMA billing code ownership

• ▪Republicans are portraying their health care cuts as fraud-fighting policies.
• ▪Current Procedural Terminology (CPT) codes are owned by the American Medical Association.
• ▪House oversight committee Chair James Comer (R-Ky.) is linking the American Medical Association's billing codes to potential fraud, waste, and abuse.

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