The career paths for knowledgeable medical coders are practically endless, but here's one I bet you've never thought of - expert witness.
When providers are audited or hauled into court cases because the feds suspect them of false claims, defense attorneys often incorporate medical coders into the defense team. That's because federal fraud investigators and prosecutors often know very little about coding, and coding knowledge can be a crucial part of the provider's defense.
So says otolaryngology coder Barbara Cobuzzi, who served as an expert witness on the defense team when the feds went after Dr. Mark Capner a few years ago. (You can read all about this landmark case in this American Medical News article.)
The Capner case is complicated, but one crux of it is that federal prosecutors didn't believe Dr. Capner performed the number of sinus surgeries he submitted claims for, even though the surgeries were documented, Cobuzzi told coders at the recent Medical Billing & Collections Conference in Orlando. Although there were coding issues with his claims (partly because he had hired a former optometry coder to do his ENT coding), he was actually undercoding his services, Cobuzzi relates.
But my biggest question for Cobuzzi is "How does a coder get an expert witness consulting gig?"
"It's all about networking," says Cobuzzi, who was AAPC's 'Networker of the Year' for 1999. She spoke at AAPC local chapter events, conferences, and other meetings and, to paraphrase an old country song, she was blogging when blogging wasn't cool. In the 1990s, she was old school, chiming in on list AAPC, AMBA and Coding Institute list serves.
The Capner case was the first she worked on that went to trial and she actually took the stand, Cobuzzi relates. But she had other expert witness jobs where she did ENT coding research for the defense in cases that eventually settled out of court. Her first expert witness job came from an orthopedic coder who'd been approached by a defense team that needed an otolaryngology coder. The orthopedic coder recommended the lawyers call Barbara for the job, because she'd seen Barbara comment on otolaryngology coding on list serves.
Want some cool networking tools? Join Supercoder's new Facebook page. Or, check out AskLeslie.net where you'll recognize Barb on the home page.