skating close to the edge with some of your coding or billing
practices, beware a sudden draft from the HHS Office of
OIG cites several cases of physician fraud in its semiannual
report for the first half of fiscal 2005. The fraud watchdog
reaped $266 from provider audits and $1.1 billion from investigations,
and federal health care programs saved nearly $17 billion
by following the OIG's recommendations.
biggest ticket item this time around may be the $1.9 million
paid by Temple University Physicians in Pennsylvania to
settle charges they submitted false claims to Medicare.
TUP's physicians allegedly didn't document, or inadequately
documented, their presence while residents and interns provided
services. The government also alleged that TUP doctors submitted
claims for upcoded evaluation and management services.
the OIG says a South Carolina doctor was excluded from federal
health programs for 26 years and sentenced to 235 months
in prison. The doctor took part in a scheme to sell prescriptions
for OxyContin, Percocet and other "controlled substances."
surgery clinic Lansing Surgery Center in Lansing, MI agreed
to pay $76,000 in civil monetary penalties to settle allegations
it submitted improper pain management claims. The physician
who supposedly provided the pain management services had
been convicted in 1999 of mail fraud, wire fraud and health
care fraud for providing medically unnecessary pain management
services and upcoding office visits.
podiatrist was ordered to pay $1.8 in restitution and serve
11 years and three months in federal prison. The podiatrist
had already been convicted of health care fraud in 1998
and then created a "fictitious transaction" to
sell his podiatry practice and get around his exclusion
from Medicare. He created a management company with a different
"owner" so he could receive income from both companies.
a California psychologist was sentenced to three years plus
$250,000 in penalties, for billing Medicare for testing,
evaluations and services that he didn't actually provide
to patients with developmental disabilities. He tried to
cover his tracks by billing under a fake "group"
number as well as his own number, and setting up four fictitious
businesses in a scheme to claim Medicare income as business
Regional Center in Florida agreed to pay $2.5 in penalties
to settle claims it billed for services that treating physicians
didn't order, plus upcoding and unbundling.