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Compliance National & Local News |
The
Office of Inspector General and other government agencies continue
to actively investigate areas of reported non-compliance. Being
aware of government auditing trends is beneficial in determining
areas for the OU Billing Compliance Office to focus on during
in-house audits. The findings of government investigations are
published on-line for public viewing.
Radiologist Indicted for Fraudulent Practices
Published on line 11/19/2009
An Atlanta-based radiologist was arraigned on November 5, 2009 on federal charges of wire fraud, mail fraud, health care fraud, and obstruction of justice. The indictment alleges that the company owned by the radiologist, provided radiologist coverage – interpreting x-rays and other films – to various hospitals in the Southeast that otherwise typically lacked full-time radiology coverage. Hospital staff took the film, which he and other radiologists at his company would access remotely via computer. The radiologist was supposed to review the film, prepare and sign a report expressing his or her medical conclusions, and transmit it electronically back to the hospital.
However, the indictment alleges that from May 2007 through January 2008, the radiologist signed and submitted thousands of reports in his name without even reviewing the films that were the subjects of the reports. Rather, he had non-physician technicians known as radiology practice assistants review the film and prepare the reports. In some cases, radiologist directed the company staff to simply sign for him, and transmit the report as it he had prepared it. In other cases, the radiologist only accessed the system for the purpose of signing and submitting the reports.
This case is being investigated by Special Agents of the Federal Bureau of Investigation and the U.S. Department of Health and Human Services, Office of Inspector General. The charges carry a maximum sentence of up to 20 years in prison and a fine of up to $250,000 for each count.
To access the Department of Justice press release, please click on Indicted Radiologist
Feds Leaning on Technology to Target Fraud
Published on line 10/14/2009
The Centers for Medicare and Medicaid Services (CMS) is hard at work creating a giant, comprehensive repository of claims and payment data from all federal health programs, including Medicaid. This will allow the government to run analytics on hundreds of millions of claims to sport aberrations and trends, a program dubbed One PI, for program integrity. It's a tool the government believes will help rein in the massive amounts of money spent on claims that are wasteful or flat-out criminal.
To learn more about the auditing program, please click on One PI
Arkansas Doctor Indicted on Health Care Fraud Charges
Published on line 10/14/2009
A federal grand jury on Thursday indicted a Pine Bluff, Arkansas doctor on fraud and other charges for allegedly providing women intrauterine devices that were not approved for sale in the U.S., then charging the state Medicaid program for a more expensive approved version. The allegations follow a Federal Drug Administration's criminal investigation and, pursued the case with Arkansas Medicaid program investigators.
During a search warrant at the doctor's former office at the Arkansas Center for Women, federal agents found "several non-approved versions of the Bayer manufactured IUD, Mirena," according to the U.S. Department of Justice news release. The doctor allegedly billed Medicaid for the more expensive, FDA-approved version of the Mirena when he was using the cheaper, non-FDA approved version.
Patients who received the unapproved versions were told by authorities to contact their primary care physicians.
"The regulatory process involved in approving new drugs exists for the sole purpose of protecting the public," said Steve Holt, Special Agent in Charge, U.S. Food and Drug Administration, Kansas City Field Office. "The agency will continue to investigate and prosecute individuals who attempt to put profits before the public health by causing the distribution of drugs that do not comply with FDA's laws and regulations."
The doctor faces one count of misbranding in violation of the Food, Drug & Cosmetic Act, one count of health care fraud and three counts of money laundering, according to a news release from the U.S. Attorney's Office in Little Rock. The maximum statutory penalty for misbranding is 3 years imprisonment and a $10,000 fine. The maximum statutory penalty for health care fraud and for each count of money laundering is 10 years imprisonment and a $250,000 fine, which the doctor may be sentenced to if convicted.
To access the entire press release, please click on Indicted Doctor
Kyphoplasty and Medical Necessity Focus of Medicare Audits
Published on line 10/08/2009
Department of Justice (DOJ) is expanding their investigation of kyphoplasty procedures, which initially resulted in the $75 million dollar settlement of the qui tam whistleblower lawsuit against Medtronic Spine (formerly Kyphon). The Department of Justice has begun issuing subpoenas requesting information regarding inpatient kyphoplasty admissions dating back through 1999. So far, 9 hospitals have settled with the DOJ totaling close to $10 million recovered.
The original "qui tam" (whistleblower) lawsuit said that, from 2000 to 2008, patients who had a certain type of spinal surgery known as "kyphoplasty" were unnecessarily kept overnight at the hospital and then classified as inpatient cases to boost the revenues. The lawsuit said, and the government agreed, that the minimally invasive procedure can usually be performed safely on an outpatient basis. The lawsuit also demonstrated that Medtronic had engaged in a marketing scheme to induce unnecessarily admits on patients who could have safely undergone kyphoplasty in the outpatient setting.
The liability of physicians may represent a key component of this investigation as well. Individual physicians are at risk for investigation under the False Claims Act. Physicians performing kyphoplasty services must clearly document the medical necessity for patients that will be admitted to the hospital. The medical record should be very specific as to the needs of the patient and not admitted on a routine basis for the procedure alone.
For additional information on the lawsuit, please click on Kyphoplasty
Pain Management Center to Pay DOJ to Resolve Medicare Fraud Allegations
Published on line 09/17/2009
A Las Vegas pain management center and five of its health care professionals have entered into a settlement agreement with the U.S. Department of Justice (DOJ) to resolve civil allegations of health care fraud to the Medicare system.
The settlement agreement, effective August 19, 2009, states that the pain management center, one anesthesiologist, two chiropractors and two physicians assistants agree to pay $167,095.94 to resolve allegations by the United States that they submitted claims to Medicare for procedures that were not considered covered benefits under Medicare policies.
The settlement agreement arose out of a civil complaint filed in U.S. District Court on June 8, 2009, against the anesthesiologist. That complaint alleged that from January 1, 2000, through the present, the pain management center and the other settling parties presented false or fraudulent claims for reimbursement to Medicare for a procedure known as Vertebral Axial Decompression (VAX-D). The U.S. Department of Health and Human Services, which administers the Medicare program, had determined that the VAX-D procedure was not medically reasonable and necessary under any circumstances, and was not a covered Medicare benefit. The complaint alleged that the anesthesiologist used codes for other services covered by Medicare in order to disguise the fact that he and others were providing non-covered services.
To access the entire press release, please click on Pain Management Center
Pfizer To Pay $2.3 Billion For Fraudulent Marketing
Published on line 09/02/2009
WASHINGTON – American pharmaceutical giant Pfizer Inc. and its subsidiary Pharmacia & Upjohn Company Inc. (hereinafter together “Pfizer”) have agreed to pay $2.3 billion, the largest health care fraud settlement in the history of the Department of Justice, to resolve criminal and civil liability arising from the illegal promotion of certain pharmaceutical products, the Justice Department announced today. The department said the $2.3 billion settlement included a $1.2 billion criminal fine, the largest criminal fine in U.S. history. The agreement also included a criminal forfeiture of $105 million. Whistleblower lawsuits filed under the qui tam provisions of the False Claims Act that are pending in the District of Massachusetts, the Eastern District of Pennsylvania and the Eastern District of Kentucky triggered this investigation.
Pharmacia & Upjohn Company has agreed to plead guilty to a felony violation of the Food, Drug and Cosmetic Act for misbranding Bextra with the intent to defraud or mislead. Bextra is an anti-inflammatory drug that Pfizer pulled from the market in 2005. Under the provisions of the Food, Drug and Cosmetic Act, a company must specify the intended uses of a product in its new drug application to FDA. Once approved, the drug may not be marketed or promoted for so-called “off-label” uses – i.e., any use not specified in an application and approved by FDA. Pfizer promoted the sale of Bextra for several uses and dosages that the FDA specifically declined to approve due to safety concerns. The company will pay a criminal fine of $1.195 billion, the largest criminal fine ever imposed in the United States for any matter. Pharmacia & Upjohn will also forfeit $105 million, for a total criminal resolution of $1.3 billion.
In addition, Pfizer has agreed to pay $1 billion to resolve allegations under the civil False Claims Act that the company illegally promoted four drugs – Bextra; Geodon, an anti-psychotic drug; Zyvox, an antibiotic; and Lyrica, an anti-epileptic drug – and caused false claims to be submitted to government health care programs for uses that were not medically accepted indications and therefore not covered by those programs. The civil settlement also resolves allegations that Pfizer paid kickbacks to health care providers to induce them to prescribe these, as well as other, drugs. The federal share of the civil settlement is $668,514,830 and the state Medicaid share of the civil settlement is $331,485,170. This is the largest civil fraud settlement in history against a pharmaceutical company.
As part of the settlement, Pfizer also has agreed to enter into an expansive corporate integrity agreement with the Office of Inspector General of the Department of Health and Human Services. That agreement provides for procedures and reviews to be put in place to avoid and promptly detect conduct similar to that which gave rise to this matter.
“This historic settlement will return nearly $1 billion to Medicare, Medicaid, and other government insurance programs, securing their future for the Americans who depend on these programs,” said Kathleen Sebelius, Secretary of Department of Health and Human Services. “The Department of Health and Human Services will continue to seek opportunities to work with its government partners to prosecute fraud wherever we can find it. But we will also look for new ways to prevent fraud before it happens. Health care is too important to let a single dollar go to waste.”
“Although these types of investigations are often long and complicated and require many resources to achieve positive results, the FBI will not be deterred from continuing to ensure that pharmaceutical companies conduct business in a lawful manner,” said Kevin Perkins, FBI Assistant Director, Criminal Investigative Division.
“The off-label promotion of pharmaceutical drugs by Pfizer significantly impacted the integrity of TRICARE, the Department of Defense’s healthcare system,” said Sharon Woods, Director, Defense Criminal Investigative Service. “This illegal activity increases patients’ costs, threatens their safety and negatively affects the delivery of healthcare services to the over nine million military members, retirees and their families who rely on this system. Today’s charges and settlement demonstrate the ongoing commitment of the Defense Criminal Investigative Service and its law enforcement partners to investigate and prosecute those that abuse the government’s healthcare programs at the expense of the taxpayers and patients.”
To access the press release from the Dept. of Health & Human Service, please click on Pfizer Settlement
To access the Office of Inspector General Corporate Integrity Agreement, please click on Pfizer CIA
Covenant Medical Center Pays $4.5 Million for Health Care Fraud
Published on line 09/02/2009
Covenant Medical Center in Waterloo, Iowa has agreed to pay the United States $4.5 million to settle allegations of health care fraud relating to the center's financial relationships with five doctors, the Department of Justice announced Tuesday. The investigation by the U.S. Justice Department and the Department of Health and Human Services began in 2005.
The United States alleged Covenant violated the law by paying commercially unreasonable compensation far above fair market value to five employed physicians who referred their patients to Covenant for treatment. These physicians were among the highest paid hospital-employed physicians not just in Iowa, but in the entire United States.
Neither Covenant nor the government would name the five doctors. But a Covenant spokesman said the doctors in question are two orthopedic surgeons, two neurosurgeons and a gastroenterologist. The hospital’s highest-paid physician, a gastroenterologist was part of the inquiry and was paid $1.8 million in 2008, but it’s unclear whether the next four highest-paid physicians were part of the inquiry.
The issue came to light several years ago when leaders of an independent medical practice, Cedar Valley Medical Specialists, complained that Covenant was offering inflated pay to doctors. For example, Covenant's top-paid doctors were making more than triple what their counterparts were making at the acclaimed Mayo Clinic in Minnesota.
Cedar Valley Medical Specialists' leader noted then that Covenant was paying more to individual doctors than it was spending on charity care for uninsured patients. Like nearly all Iowa hospitals, Covenant is classified as a charity that is exempt from most taxes because of the assistance it purportedly provides to the poor. The specialists' group filed a lawsuit against Covenant, which it settled last year.
This settlement resolves allegations that Covenant Medical Center submitted false claims to Medicare by engaging in financial relationships with five physicians that were prohibited under the Stark Law. The Stark Law prohibits a hospital from profiting from referrals of patients by a physician when the hospital and physician have an improper compensation arrangement. An arrangement is improper if a physician is paid above fair market value for their services and that compensation is not commercially reasonable. The purpose of the Stark Law is to ensure physicians' medical judgments are not compromised by improper financial incentives and are
based solely on the best interests of the patient.
In a settlement agreement, Covenant denied any wrongdoing but agreed to pay the United States $4.5 million plus interest to settle the government's claims. Covenant believes the government did not produce any evidence that Covenant had engaged in wrongdoing or illegal conduct. Officials at Covenant Medical Center say they made a business decision to settle to avoid the uncertainty of litigation, disruption, and high expense associated with protracted litigation with the government, despite their belief that Covenant's compensation to its physicians was reasonable and fell within fair market value.
To access the complete news article, please click on Covenant Hospital
To access the Department of Justice release, please click on DOJ Settlement
False Claims Act Amendments of 2009: Effect on Fraud Investigations
Published on line 08/14/2009
On May 20, 2009, President Obama signed into law the Fraud Enforcement and Recovery Act of 2009 (“FERA”), which included the first broad ranging amendments to the civil False Claims Act (“FCA”) since 1986. These amendments will have a dramatic impact on FCA investigations and litigation brought by both the government and qui tam relators against a broad cross-section of American businesses and institutions.
However, Section 4 of the FERA has major significance for health care providers. This section, “Clarifications to the False Claims Act to Reflect the Original Intent of the Law" redefines “obligation” to include “an established duty, whether or not fixed,” arising from a variety of relationships, and specifically includes obligations “arising from statute or regulation, or from the retention of any overpayment.”
This change allows the government and whistleblowers to pursue violations of regulatory statutes with penalty provisions as False Claims Act cases and to pursue false documents which are “material to an obligation to pay or to transmit money…to the Government” regardless of whether a false claim has been submitted. For example, a physician who creates backdated medical records to support a claim already submitted could be liable under this provision.
The new language in this amendment is likely to have a significant impact on the range and number of new False Claims Act cases.
To access the brief information from the Medicaid Inspector General, please click on FERA Effect on Medicaid
To access the entire statute, please click on Amendment S.386
LSUHSC Pays $706,678 to Settle Federal Fraud Suite
Published on line 08/04/2009
Federal prosecutors say LSU Health Sciences Center-Shreveport will pay more than $700,000 to settle allegations that it defrauded Medicare by billing for medical services not provided by teaching physicians between 1995 and 2005. In addition to the payment, for three years LSUHSC-Shreveport must maintain its compliance program, report overpayments, notify the government of any ongoing investigations or legal proceedings, file annual reports, submit to audits and retain its records, according to a certification of compliance agreement between the local facility and the inspector general's office in the Health and Human Services Department.
The investigation found that the facility routinely submitted claims for payment to Medicare Part B on behalf of doctors who said they helped orthopedic residents during surgery when in fact they were not present for the procedure as required. Obtaining the payments from Medicare requires physicians to specifically describe and certify the scope and extent of their role during surgical procedures performed by residents, the release states. In the time freed up by not attending these surgeries, the doctors named in the suit treated "private pay patients", alleges the lawsuit.
The fraud was exposed by a former teaching physician in the orthopedic department and a registered nurse under the qui tam provision of the False Claims Act. The two whistleblowers contend the doctors named in the suit routinely absent from surgical procedures to which they were scheduled to attend. Irrespective of the fact of their physical absence, (the doctors) repeatedly signed billing slips indicating their presence at hundred and possibly thousands of surgical procedures ... for the purpose of billing Medicare and Medicaid. In addition, the hospital divided the federal reimbursements between the hospital and the teaching physicians.
To access the press release, please click on LSU Case
Fraud Case Against the University of Medicine and Dentistry of New Jersey Finally Concluded
Published on line 06/17/2009
The University of Medicine and Dentistry of New Jersey (UMDNJ) fraud case was concluded on June 10, 2009 as reported by the U.S. Department of Justice (DOJ). The final settlement ends the criminal and civil case which began in 2005 and was brought about by a whistleblower.
From 1993 to 2004, UMDNJ’s University Hospital submitted claims to Medicaid for outpatient physician services that were also being billed by doctors working in the hospital’s outpatient centers. By submitting duplicate claims for payment, University Hospital effectively doubled billed the government’s Medicaid program. The University was charged
with deliberately double-billing both Medicaid and Medicare by nearly $5 million.
The billing issues at UMDNJ were complex and the hospital and its doctors were constantly at odds with each other over the matter. More than a decade earlier, memos show, university officials were cautioned numerous times about the billing problems -- warnings that were repeatedly ignored as both sides continued to bill for the same services
The faculty physicians based validity of their billing on a 1984 court ruling that the faculty members' claim that only they could bill for patient services. However, university administrators insisted the doctors were hospital employees and only the hospital could bill. As a result, both sides billed Medicaid and Medicare millions of dollars for the same patient services.
UMDNJ agreed to reimburse to the federal and state governments a total of $4.9 million (of which $2.065 million has already been paid to the government). The $4.9 million represents the amount of willful double-billing known to date; any other amounts determined in the investigation to have been received unlawfully or in error by UMDNJ must also be reimbursed. After the university paid back the money it had overbilled, it still had to resolve the civil liabilities it faced with the Justice Department and the state Department of Health and Human Services. The school agreed to pay an additional $2 million.
In addition to the monetary settlement, The University was appointed a federal monitor with wide
discretion and powers to enforce and ensure compliance with the terms of the settlement. The DOJ
made clear that the settlement does not protect or absolve any individuals who may have been involved in criminal conduct. The criminal investigation is continuing and charges will be brought as necessary and appropriate.
"Today's settlement demonstrates that the Department of Justice will not tolerate fraud on our Medicaid programs, which were created to serve our nation's low-income families, children and seniors," said Tony West, assistant attorney general for the Justice Department's Civil Division.
"We still have the right to pursue individuals who were responsible," he said
To access the Department of Justice report, please click on UMDNJ Press Release 06/2009. There is also a previous press release from the DOJ for the initial fraud report. To access the information, please click on UMDNJ Press Release 12/2005
Medical Center Pays $2.5 Million For Allegations of Improper Claims
Published on line 06/08/2009
Queen's Medical Center ("QMC") of Honolulu, Hawaii has paid a total of $2.5 million to settle two lawsuits alleging that QMC over billed the Medicare program, the State of Hawaii Medicaid program, and TRICARE, the federal health benefits program for military dependents. The settlement grew out of civil "whistleblower" suits brought in federal and state court
under the federal and State of Hawaii False Claims Acts.
Edward H. Kubo, Jr., United States Attorney for the District of Hawaii, said that
QMC submitted false bills for pharmaceuticals dispensed at the hospital, and billed federal programs for services provided by residents without the level of supervision required by federal rules. According to the settlement agreement signed on April 27, 2009, the federal and state governments contended that:
- (1) from September 8, 1999 through October 28, 2002, QMC submitted false claims to Medicare, Medicaid and TRICARE seeking payment for the dispensation of anti-psychotic medications allegedly ordered by a psychiatrist, whereas the medications were actually ordered by non-psychiatrist physicians without the prior knowledge of a psychiatrist; and
- (2) from July 1, 1999 through June 30, 2006, QMC wrongfully submitted claims to Medicare, Medicaid, and TRICARE for services it represented were provided by teaching physicians when QMC did not have the documentary evidence necessary to demonstrate that the teaching physicians were involved in the services to the degree necessary to support payment of the claims.
“Settlements such as this demonstrate yet again that submitting false claims to federal health care programs artificially raises health care costs and in turn takes from those who depend on these government medical programs,” said Glenn R. Ferry, Special Agent in Charge for the Los Angeles Region of the Office of Inspector General, U.S. Department of Health and Human Services. “My agency, working with our federal and state law enforcement partners, will continue to aggressively investigate and prosecute such fraud.”
To access the complete information, please click on QMC Settlement
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Attorney General and HHS Secretary Announce New Interagency Health Care Fraud Prevention and Enforcement Action Team
Published on line 05/26/2009
The Attorney General and Health & Human Services (HHS) Secretary
announced the creation of a new interagency effort, the Health Care Fraud Prevention and Enforcement Action Team (HEAT), to combat Medicare fraud on May 20, 2009.
"With this announcement, we raise the stakes on health care fraud by launching a new effort with increased tools, resources and a sustained focus by senior-level leadership,” said Attorney General Holder. “Every year we lose tens of billions of dollars in Medicare and Medicaid funds to fraud. Those billions represent health care dollars that could be spent on medicine, elder care or emergency room visits, but instead are wasted on greed. This is unacceptable, and the Justice Department is committed to working with the Department of Health and Human Services to eradicate it.”
The HEAT team will include senior officials from DOJ and HHS who will build upon and strengthen existing programs to combat fraud while also investing new resources and technology to prevent fraud, waste and abuse before it happens. Prevention is critical to reforming the system and the HEAT team will also focus critical resources on preventing fraud from occurring in the first place.
Fraud prevention efforts are also strengthened in President Obama’s proposed Fiscal Year 2010 budget. The President’s budget invests $311 million -- a 50 percent increase from 2009 funding -- to strengthen program integrity activities within the Medicare and Medicaid programs. Combined, the anti-fraud efforts in the President’s budget could save $2.7 billion over five years by improving oversight and stopping fraud in the Medicare and Medicaid programs.
To access the complete details of the HHS press release, please click on HEAT team information
Pharmaceutical Company Charged with Marketing Drugs for Unapproved Pediatric Use and Paid Kickbacks to Providers
Published on line 05/26/2009
The Department of Justice (DOJ) has filed a complaint against a New York pharmaceutical company for alleged False Claims Act violations arising from the company's marketing the drugs Celexa and Lexapro for unapproved pediatric use and for paying kickbacks to induce physicians to prescribe the drugs.
In February, the DOJ unsealed a whistleblower complaint that alleged the company violated the False Claims Act and paid kickbacks to physicians to get them to prescribe the drugs. The company induced physicians by providing them with illegal remuneration such as cash payments disguised as grants or consulting fees, expensive meals or entertainment, which violate the anti-kickback statute. This caused thousands of false and fraudulent claims to be submitted to federal health care programs.
In response to the allegations, the pharmaceutical company has set aside $170 million while in discussions with the DOJ about the investigation into the alleged kickbacks paid to physicians, the company said in a prepared statement. Accordingly, until the investigation is resolved, there can be no assurance that the amount reserved by the company will be sufficient and that a larger amount will not be required.
To read complete details of the complaint, please click on DOJ Press Release
Oncologist Charged with Health Care Fraud
Published on line 04/08/2009
A Virginia Beach doctor was indicted in federal court on charges of defrauding government health care programs. On April 3, 2009, the doctor
was charged by a Norfolk federal grand jury in a forty-five count indictment with health care fraud, making false statements relating to health care matters, and alteration of records to obstruct an investigation. As a result of these fraudulent claims, Poulin obtained over $850,000 in health care benefit payments from Medicare and Tricare to which he was not entitled.
The indictment alleges
between January 2006 through August 2008, the doctor fraudulently billed Medicare and Tricare for a greater amount (increased units) of chemotherapy drugs than he actually administered to patients and for office visits that involved a more thorough medical examination than he actually rendered to patients (up-coding). The doctor
falsified, and directed members of his staff to falsify, patient medical records subpoenaed during the investigation of this case.
The doctor also
diagnosed patients with renal disease in order to bill Medicare and Tricare for the administration of Procrit although he knew administering the drug to these patients was not medically reasonable. However, the diagnosis was made to support medical necessity of the services.
To read the complete DOJ press release, please click on Oncologist Charged
Cardiologist Settles False Claims Act Case
Published on line 04/08/2009
A Kansas cardiologist and his practice group, have agreed to pay the United States$1.3 million to settle claims that the physician and his group violated the False Claims Act (FCA) between 2001 and 2006,by submitting false claims to Medicare
announced in a press release from the Department of Justice (DOJ) on March 3, 2009. The government stated the two main violations were claims submitted for services not provided and claims submitted without proper documentation.
According to the DOJ, this is the second FCA case the doctor has been charged with. In May 2000, the cardiologist and his medical group agreed to pay more than $1.5million to settle a previous False Claims Act matter. In that case, the government contended that between 1993 and 1998, the doctor billed Medicare for higher levels of services than provided (up-coding), billed twice for the same services (double-billing), and billed for services not provided.
For the recent case and part of the $1.3 million settlement, the cardiologist and his medical group have entered into an Integrity Agreement with the U.S. Department of Health and Human Services, Office of Inspector General. The Integrity Agreement contains measures to ensure compliance with Medicare regulations and policies in the future.
The settlement of the second case was the result of a coordinated effort among the Commercial Litigation Branch of the Justice Department's Civil Division; the U.S. Attorney's Office for the District of Kansas; and the Department of Health and Human Services' Office of Inspector General and Office of Counsel to the Inspector General.
To read the complete DOJ press release, please click on Kansas Cardiologist
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Physician Found Liable of Medicare Fraud
Published on line 02/25/2009
A federal jury today found a Las Vegas anesthesiologist liable of committing federal health care fraud for submitting over 3,500 false or fraudulent claims to the United States Government between 1999 and 2006 for consultation services not requested or provided, announced Greg Brower, United States Attorney for the District of Nevada. The physician was charged in a civil complaint with violating the federal False Claims Act.
“The Department of Justice in Nevada will continue to pursue physicians who present false claims to the Government,” said U.S. Attorney Brower. “Anyone found violating the False Claims Act, faces triple the proven damages, as well as civil penalties and costs of prosecution.”
The jury found that the physician submitted claims for consultation services that he had not been requested to perform and/or had not performed. In reliance on doctor's false certifications on the claim forms, Medicare paid reimbursements to the doctor totaling approximately $421,000. This amount will automatically be tripled under the False Claims Act, to approximately $1.26 million. Medicare would not have paid such claims had the doctor provided truthful information.
On April 14, 2009, a hearing will be held to determine the amount of civil penalties to be awarded to the United States under the False Claims Act. The Government is requesting between approximately $1 million and $2 million in penalties.
For more details, please click on Physician Fraud
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News
Local Doctor Guilty of Health Care Fraud
Published on line 02/25/2009
Oklahoma City federal jury found a local doctor guilty of 53 counts of illegally dispensing thousands of tablets of controlled prescription drugs, health care fraud and obstruction of justice, according to John C. Richter, U.S. attorney for the Western District of Oklahoma.
“The rule of law applies to all,” Richter said. “As the verdict shows, this doctor violated his oath to heal in order to be simply a drug dealer of painkillers known for addictiveness and abuse. But he did not stand pat with just those crimes. Instead, he then billed the American taxpayer, through Medicaid, for his illegal drug dealing. And then, when he learned he was being investigated, sought to obstruct our investigation through falsifying patient records subpoenaed by the government.”
The trial last approximately four days. The jury deliberated for about 45 minutes before finding the physician guilty on all 53 counts. A sentencing date will be set by the court in about 90 days, officials said. The doctor faces up to 20 years in prison and a fine of up to $1 million. The jury also found that, after receiving a subpoena for patient records April 7, 2008, as part of the investigation, the doctor falsified patient records with the intent to impede, obstruct and influence the investigation, Richter said.
Richter said the doctor issued prescriptions without conducting physical examinations, taking vital signs or ordering tests, and individuals who were addicted to the drugs knew they could see the doctor and within minutes receive a prescription. “Evidence showed that individuals were lined up outside his office before it opened in order to receive the prescriptions on a first come, first served basis,” Richter said.
The physician submitted fraudulent claims for reimbursement to the Medicaid system, Richter said. Evidence showed the doctor submitted claims on behalf of a patient never seen or treated, and on behalf of individuals for whom he claimed to have performed comprehensive examinations when, in fact, he had spent only minutes with the individual seeking the drugs, Richter said.
To read the complete details of this article, please click here - Local Doctor
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