News & Events

(April 9, 2018) The Grab for Dollars: Decoding the Upcoding MedReview’s Case Study in Endoscopic Drainage

The Grab for Dollars: Decoding the Upcoding MedReview’s Case Study in Endoscopic Drainage


A 62-year-old male hospitalized for a duodenal ulcer with hemorrhage required a colonoscopy as part of his workup. During the procedure, the endoscopist noted that there was fecal material blocking the scope’s field of view and used the endoscope’s irrigation system to flush the material out of the way. Upon the patient’s discharge, the hospital added to its diagnostic and procedural coding for this case the code for “therapeutic lavage and drainage of the colon.” This DRG carried a charge of $71,000, or $35,000 more than the bill would have been without the upcoding.

“It is routine during a colonoscopy to lavage with water when visualization is impaired. Scopes have built-in water irrigation systems for just this reason,” states Seth Lewin, MD, Chief Medical Officer at MedReview. “Irrigation during endoscopy to better visualize the bowel in order to obtain an accurate diagnosis is routine and should not be billed as if it were a treatment separate and distinct from the diagnostic endoscopy.”

NYCHSRO/MedReview denied the additional coding for endoscopic lavage and drainage, reducing the billable DRG amount to $36,000.  The hospital doctors appealed, but the reviewers upheld our original coding.

“Attempts such as this to obtain enhanced payment for patient care are far from uncommon,” notes Dr. Lewin.  “In this instance, the effect of the upcoding was to nearly double the billed amount. MedReview recently reported a similar case in which the hospital coded administration of daily eye drops to a patient each morning as if it were an operative procedure, increasing the DRG payment by $2500. In the current instance of upcoding for therapeutic lavage and drainage of the colon, the cost impact was fourteen times as great and was equally and absolutely unjustifiable.”


ORIGINAL BILL:                 $71,000.00

RECODED BILL:                  $36,000.00

CLIENT SAVINGS:             $35,000.00

(Wednesday, April 4, 2018) IRS Dirty Dozen: Watch Out for these 12 Scams 

Issue Number:    IRS Tax Tip 2018-52

IRS Dirty Dozen: Watch Out for these 12 Scams 

The IRS reminds taxpayers to watch out for scams and schemes that put them and their personal information at risk. Each year, the IRS releases the top 12 scams, known as the Dirty Dozen. The schemes run the gamut from simple refund inflation to technical tax shelter deals.

Here’s a recap of this year’s Dirty Dozen:

  1. Phishing: Taxpayers should watch for fake emails or websites looking to steal personal information. The IRS will never initiate contact with taxpayers via email about a bill or tax refund. Don’t click on links in these emails claiming to be from the IRS.
  2. Phone Scams: Phone calls from criminals impersonating IRS agents remain an ongoing threat to taxpayers.
  3. Identity Theft: Taxpayers should be alert to tactics aimed at stealing their identities. The IRS continues to pursue criminals who file fraudulent tax returns using someone else’s Social Security number.
  4. Return Preparer Fraud: Most tax professionals provide honest, high-quality service. However, there are some dishonest preparers who scam clients. These preparers commit refund fraud, identity theft and other scams that hurt taxpayers.
  5. Fake Charities: Groups masquerading as charitable organizations solicit donations from unsuspecting contributors. People making donations should take a few extra minutes to make sure their money goes to legitimate charities.
  6. Inflated Refund Claims: Taxpayers should be wary of anyone promising inflated tax refunds. Some signs of this include preparers who ask clients to sign a blank return or those who promise a big refund before looking at taxpayer records.
  7. Excessive Claims for Business Credits: Taxpayers should avoid improperly claiming the fuel tax credit. Most taxpayers aren’t eligible for this credit, as the law usually limits it to off-highway business use, including farming.
  8. Falsely Padding Deductions on Returns: Taxpayers should avoid the temptation to falsely inflate deductions or expenses on their tax returns. Taxpayers do this to pay less than what they owe or receive a larger refund than they should get.
  9. Falsifying Income to Claim Credits: Con artists may convince taxpayers to invent income to erroneously qualify for tax credits, such as the Earned Income Tax Credit.
  10. Frivolous Tax Arguments: Some taxpayers use frivolous tax arguments to avoid paying tax. Promoters of these schemes encourage taxpayers to make outlandish claims about the legality of paying taxes. These claims are repeatedly thrown out in court.
  11. Abusive Tax Shelters: Taxpayers who use abusive tax structures do so to avoid paying taxes. The majority of taxpayers pay their fair share, and everyone should be on the lookout for people peddling tax shelters that sound too good to be true.
  12. Offshore Tax Avoidance: It’s a bad bet to hide money and income offshore. People involved in offshore tax avoidance are best served by voluntarily disclosing offshore money and getting caught up on their tax-filing responsibilities.

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(Monday, March 22, 2018) PA Workshop Ensures Best Practices in Coding Validation Reviews

PA Workshop Ensures Best Practices in Coding Validation Reviews

MedReview’s periodic Physician Advisor Workshops took place this quarter on January 10 and March 22, the first concerning pediatrics and the other, internal medicine, and both dedicated to MedReview’s unique healthcare audit service: code validation.

The company’s top physicians facilitated the meetings, which are intentional dialogues between department directors and doctors to ensure consistency in the validation process and its outcomes.  CMO and VP Seth Lewin, MD, and Senior Medical Director Edward L. Saxer, MD, led the internal medicine workshop; Medical Director of Pediatrics Richard J. Bonforte, MD, FAAP, led the other.

“We have these meetings to get everyone up to date and on the same page regarding the audit process and quality assurance issues. The managers of our review departments bring an expert coding perspective that complements the doctors’ review,” says Dr. Bonforte.

The goal, he explains, is to “ensure that the assigned insurance code for a patient’s care—which determines the cost of that care—matches the actual services, medication and procedures provided. For example, if there is a code indicating that hospital staff treated a patient for a flu and administered certain treatments and care, does the documentation in the hospital record validate that treatment and care?”

“We audit the patient’s medical chart,” he states. “We look at such questions and problems to get the doctors and coders on the same page.”

In total, twenty directors, reviewers and physicians participated in the workshops.


(Sunday, March 18, 2018) CEO Stamm Celebrates Community Activists & Politicians at COJO Legislative Breakfast

CEO Stamm Celebrates Community Activists & Politicians at COJO Legislative Breakfast

CEO Joseph Stamm joined 250 activists and leaders on March 18 at the 39th Annual Community Legislative Breakfast of the Council of Jewish Organizations of Flatbush. The event awarded nine individuals for leadership and excellence in public and legislative service, banking and commerce, medicine, volunteerism, philanthropy, and education. This year’s honorees were:  NYS Majority Leader John J. Flanagan; NYC Council Speaker Corey Johnson; Kings County DA Eric Gonzalez; NYS Assemblyman Walter T. Mosley; President and CEO of Maimonides Hospital Kenneth Gibbs; IBE Trade Corporation President Alex Rovt; Rabbi Yosef Eisen of Kollel Bnei Torah and Kehilah Kashrus; Capital One Bank Market Manager Connie Waterman; and COJO Volunteer Rachel Navifar.

“The COJO breakfast is a unique opportunity to mingle with government officials and business leaders and talk about what MedReview is doing to serve the healthcare industry and the public,” states CEO Stamm.

A non-sectarian, non-profit social services agency, COJO addresses an array of community concerns such as education, entitlements, employment, housing, and youth development through linkages with private and civic organizations. In the past year, COJO has provided over 25,000 clients with more than 58,000 services through its programs.

(Sunday, March 18, 2018) Political Roundup

On New Year’s Day, CEO Joe Stamm began his annual rounds of the political circuit at City Hall where he joined 900 fellow citizens who braved frigid cold temperatures to celebrate the second inaugurals of New York’s top three officials: Mayor Bill de Blasio, Comptroller Scott Stringer, and Public Advocate Letitia James.

Senator Bernie Sanders administered the mayor’s oath of office and praised de Blasio for making his city “one of the most progressive” in the nation. The Mayor spoke about his first-term accomplishments and his second-term aspirations, citing the city’s lowest murder rate since 1951 due to his neighborhood policing policies and pledging more affordable housing and good paying jobs for working people.

The Comptroller talked about the “62,000 New Yorkers sleeping in homeless shelter” and pledged to create “real, local wealth” in every neighborhood. “We cannot be a city where the entrance fee is a two-million-dollar condo,” he said. Public Advocate James focused on the need for police and community partnerships and public housing “free of dangerous lead.” “More homes” are the “best solution to homelessness,” she said. “All New Yorkers want a safe neighborhood where police and community are partners and where your success is determined by your hard work and God-given potential. These are not Republican or Democratic values. These are not even just New York values. These are American values.”

Afterwards, Mr. Stamm celebrated with each of the winners: James at Manhattan Proper; Stringer at Wooly Publixe; and de Blasio at the Tweed Courthouse.

Two days later, MedReview’s CEO and Director of Corporate Outreach Maurice Bortz went to Albany to hear Governor Andrew Cuomo deliver his final State of the State of his second term in office. He opened his speech with his bona fides as a leader of progressive government, invoking the names of two illustrious predecessors in this political stream: his father, Mario Cuomo, and President Franklin D. Roosevelt, who also once served as New York’s top official.

“Our economy is stronger today and we are once again the nation’s beacon for social progress,” Cuomo declared, citing achievements ranging from reduced crime, a cleaner environment and land conservation to “historic” investments and fiscal discipline….Every New Yorker’s tax rate is lower today than when I took office. We have the highest credit rating in 40 years, unemployment is down from 8.3 percent to 4.7 percent, and down in every single region of the state. Today New York State has 8.1 million private sector jobs—the highest number of jobs in history.”

Cuomo also called out the “unprecedented challenges ahead” due to Washington’s intention to dismantle hard-won victories against discrimination, sexism, terrorism, environmental threats, and opioid addiction, and to impose a tax on state and local income that would “threaten the essence of our economy.” His own economic and social development strategies for New York addressed women’s issues, health care and educational opportunities, criminal justice, homelessness, immigrant and worker rights, veterans, infrastructure, and environmental issues such as pollution, climate change as well as access to open space.

On February 13, CEO Stamm was at the Kings Theater in Brooklyn to hear Mayor Bill de Blasio deliver his first State of the City address of his second and final term in office. With a subtle twist on a recent presidential slogan, the Mayor promised to “make New York City the fairest big city in America.” Then citing his accomplishments to date including record low crime rates, pre-K access for every four year old and improved student test scores, de Blasio said, “We came into office determined to preserve the greatness of New York City…. We set audacious goals, and we have exceeded those goals.”

Finally, on March 18, CEO Stamm joined 250 activists and leaders at the 39th Annual Community Legislative Breakfast of the Council of Jewish Organizations of Flatbush to recognize nine outstanding local leaders:  NYS Majority Leader John J. Flanagan, NYC Council Speaker Corey Johnson, Kings County DA Eric Gonzalez, NYS Assemblyman Walter T. Mosley, Maimonides Hospital CEO Kenneth Gibbs, IBE Trade Corporation President Alex Rovt, Rabbi Yosef Eisen, Capital One Bank Market Manager Connie Waterman, and COJO Volunteer Rachel Navifar.

(Tuesday, March 13, 2018) Ranking Member of Congressional Committee on Oversight and Government Reform Talks Healthcare Cost Containment and More in MedReview Boardroom

Ranking Member of Congressional Committee on Oversight and Government Reform Talks Healthcare Cost Containment and More in MedReview Boardroom

US Congressman Raja Krishnamoorthi, the ranking member on the House Committee of Oversight and Government Reform from Illinois’s 8th District, joined CEO and President Joseph Stamm, his wife Anne, and key staff for a luncheon and talk in NYCHSRO/MedReview’s boardroom on Monday, March 12.  A first-term representative from suburban Chicago and a former Special Assistant Attorney General and Deputy Treasurer for his home state, he is a graduate of Princeton University and Harvard Law School. He is also a first-generation American, whose parents emigrated from India, and one of only four Hindus currently serving in the House of Representatives.


The Congressman opened his remarks by recounting the story of his son’s response last year when he told him he had been “sworn into office.” “What bad words did you have to say?” the eight year old asked him. When the laughter subsided, Representative Krishnamoorthi told the room, “I did not come here to say bad words, but good words—and what I am doing going forward.”


The topics of conversation centered on two key concerns of CEO Stamm, the first being American healthcare and healthcare reform, and the second, the rising recurrence here and abroad of anti-Semitism and anti-Jewish sentiment regarding the State of Israel.


As the top Democrat on his congressional committee and its Subcommittee on Healthcare and Financial Services, Rep. Krishnamoorthi spoke in depth of his dedication to lowering consumer healthcare costs and his policy platform, which focuses on growing and strengthening the middle class by supporting small business, making college more affordable, rebuilding infrastructure, and protecting Social Security and Medicare. He noted that his wife is an anesthesiologist and mother of three, a fact that brings directly home to the Krishnamoorthis the subject of rising costs of medical care, pharmaceuticals, and insurance.


Mr. Stamm and his executives at the board table raised questions germane to their professional and personal lives, including the issues of cuts to Medicare and the refusal by many New York doctors to accept Medicare at all. Board Member Richard J. Bonforte, MD, FAAP, observed that a good first step would be to get rid of the word “entitlement” regarding Medicare. These are “earned benefits, not freebees or handouts,” he stated. Noting that Medicare payments are monies people have put aside for themselves through payroll deductions, Dr. Bonforte pointed out that we “even pay taxes on the income.”


Acknowledging the many Americans whose parents are on Social Security and Medicare after a lifetime of work, Krishnamoorthi called the question deeply personal. “The benefits should be there for you,” he stated unequivocally. “Can there be some reform? Yes. But we shouldn’t change the system all of a sudden for people nearing retirement age.”


Remarking on the rate of doctors dropping out of the Medicare system altogether, the Congressman talked about the good news and bad news. On the one hand, large hospitals are “gobbling up” communities and the doctors in them, and then requiring these physicians to take all insurances accepted by the hospital. On the other hand, reminding the group that his wife is a doctor, the Congressman conceded reflectively, “We’d have to raise the rate in Medicare payment to incentivize them, and the mood in DC is not there now.”


Noting another way rising healthcare costs impact MedReview and its clients, SVP of Operations Spencer Young spoke of the growing problem of outrageous bills to patients for services allegedly rendered during hospital stays. He gave the example of a hospital charge we reviewed of $8000 daily for an “invasive procedure” to the eye when all they had done was administer Visine drops on a preexisting prescription. “We see it here every day,” declared Young.


Rep. Krishnamoorthi was duly amazed. “When I talk to participants in the healthcare system, they point fingers at everyone else—hospitals, doctors, pharmaceutical companies, patients—they are all part of the mix.”  With a tone of resignation to current political realities, he said everyone “will have to sacrifice a little to bend the curve of costs.” The good news, he added, is that the issue is bipartisan in nature. “Universally, people are upset about rising costs.”


Calling the issue of prescription drug pricing “one of the most difficult,” he discussed the ways his committee is addressing these costs.  Among other things, he is working with Congressman Jim Jordan (R-IL) on changing restrictive practices by pharmaceutical companies to prevent the sale of generic drugs. “Even though we negotiate prices with manufacturers, they are still too high. We clearly pay much more than any other country for the same drugs,” he said. “We are subsidizing their discount. The USA subsidizes R&D in pharma. We should allow importing of pharmaceuticals from other countries,” he declared. “I am going to do all I can to erase barriers to generics.”


MedReview’s chief raised the topic of Obamacare and “the many good things about it” such as coverage for preexisting conditions and unmarried children. Noting the steep and continuing drop in the number of healthcare exchanges, CEO Stamm asked, “Is there any movement between the two parties to deal with this?”


“We need a joint solution to stabilize the markets,” the Congressman replied. “Mitch McConnell promised a vote and we are awaiting it. We haven’t seen the fruit of the promises.” Speaking of his colleagues across the aisle in the Republican-led Congress, Krishnamoorthi added, “They have vowed to kill Obamacare. Voting itself is a long term issue,” he said in reference to Speaker Ryan’s consistent refusal to call a vote without a majority of his caucus. “We need to change the voting system from a majority of the ‘majority’ to a majority of the vote,” Krishnamoorthi declared.


The boardroom conversation also addressed concerns related to Israel. In fact, Rep. Krishnamoorthi was at the MedReview offices at the invitation of Ezra Friedlander of The Friedlander Foundation, which is seeking bipartisan support to award Anwar Sadat, the late Egyptian president and Mideast peacemaker, with the Congressional Gold Medal. Mr. Stamm co-chairs this effort. The Congressman gave his views not only on Israel but also on the rising tide of anti-Israel sentiment and, concomitantly, antisemitism here and abroad. Noting that he has visited Israel on a mission with the American Jewish Congress, he stated, “I will continue to be a strong supporter of Israel…and hope we can keep this country’s special relationship to Israel outside of politics.”


Adding that his children attend school at the local JCC because “it is the best in the area,” the Congressman said the school has received threats along with Latinos in the community. Referring to the “rise in a lot of isms right now” and the “pro-Zionist but antisemitic” trend in Congress, he also said, “I’ll call a spade a spade. There are certain elements in the highest levels of government that trade in this type of antisemitism. In my humble opinion, we have to combat antisemitism wherever it rises its ugly head, whether on the left or far right.”


“I am one of the strongest supporters of Israel in Congress,” he asserted. In a moment of levity, he added that when his boys come home from school on Friday evening, they call out Shabbat Shalom, hey!—the Hebrew greeting for a good Sabbath followed by the traditional exclamation celebrating Hindu festivals.

(February 18, 2018) Key Staff Is Rink Side for Islanders vs. Rangers Faceoff

Key Staff Is Rink Side for Islanders vs. Rangers Faceoff

When New York’s archrival hockey teams faced off on the ice at Brooklyn’s Barclay Center on February 15, NYCHSRO/MedReview’s management team and their spouses cheered from the stands.  Joe and Anne Stamm, Spencer and David Young, Robert and Susan Rosenbloom, Maurice and Rivki Bortz, along with Stuart and Tzippy Stillman, celebrated with fellow fans as the Islanders took the Rangers 3-0.



CEO Stamm was among throngs of friends and well-wishers at the Kings Theater in Brooklyn on February 13 to hear Mayor Bill de Blasio deliver the first State of the City address of his second and final term in office, in which the declared his promise to “make New York City the fairest big city in America.”

Citing his historic accomplishments to date including record low crime rates, access to pre-K for every four year old, and improved student test scores citywide, the mayor said, “We came into office determined to preserve the greatness of New York City: today, tomorrow, and for generations. We set audacious goals, and we have exceeded those goals.”

“Wherever I go,” he added, “I hear from people who want to make sure…this remains an open place, an inclusive place, a place for everyone. Now, we have four more years to go further, move faster, and do more.”