North Wildwood doctor netted $35 in alleged billing fraud, expert testifies - pressofAtlanticCity.com: Breaking News

North Wildwood doctor netted $35 in alleged billing fraud, expert testifies - pressofAtlanticCity.com: Breaking News

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North Wildwood doctor netted $35 in alleged billing fraud, expert testifies

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Posted: Thursday, October 25, 2012 10:34 am | Updated: 9:12 pm, Fri Oct 26, 2012.

CAPE MAY COURT HOUSE — Seven visits by an undercover police officer generated seven health care claims bills netting North Wildwood physician John Costino a sum of $35.93 in overpayments, a billing expert testified Thursday.

Glenda Hamilton, a clinical documentation educator from Cooper University Hospital in Camden, testified for the defense that of those seven bills, Costino billed correctly three times, upcoded or billed too high on two occasions and downcoded or billed too low on two occasions.

Hamilton explained to the jury in Costino's drug distribution and health care claims fraud trial the process used by doctors, hospitals and others to bill for their services using a standardized coding system.

The components of the bills, she said, included information the physician gathered on a patient's history, the physical examination and medical decision making.

Hamilton went through each of the seven visits undercover Little Egg Harbor Township police officer Tonya Anderson made between April and August 2007. She posed as an exotic dancer in Atlantic City needing a prescription to let her unwind after work.

Hamilton said she used the doctor's records, billing information and the transcripts of the visits, recorded without Costino's knowledge, to determine what billing codes should have been used.

She said that on three visits the doctor used the correct codes. On the others, she found the doctor either used codes one level above or below what she said was the correct billing code.

The total amount of money he collected was under $500, and Hamilton said that, given the occasions when he used a code below what was correct, he netted $35.93 more than he should have.

Her testimony, however, differed from prosecution expert Patricia Ross, who testified that Costino submitted incorrect bills on all seven of Anderson's visits.

Assistant Prosecutor Ed Shim said Ross found Costino upcoded on all seven occasions.

Anderson also completed her testimony Thursday telling jurors that she and a second undercover officer were unsuccessful in their attempts to get Costino to write them a prescription for Oxycontin.

Costino wrote prescriptions for Percocet, a painkiller, to both women when they visited his office in 2007 posing as exotic dancers.

But Costino would not give them prescriptions for Oxycontin calling it a "problem drug" and telling them it was reserved for people with "significant" medical issues.

"You don't want to get involved in that," he told them.

Costino also told the women to only take Percocet one at a time when they asked about taking more than that.

The day's last witness was Alexander Sylvester an inspector with the U.S. Postal Service. Sylvester who said he had one of his analysts transcribe the recording of the Aug. 3 meeting between Costino and the two undercover officers.

The transcript has been the source of some dispute because when first transcribed it had the second undercover officer using the phrase "it's just the pain."

A DEA official already testified that the women were never to tell Costino they suffered from any pain.

The transcript was later changed because a DEA investigator said the woman actually said the word "same" and not "pain."

The trial will continue today and into next week.

Contact Trudi Gilfillian:

609-463-6716

TGilfillian@pressofac.com

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