Header graphic for print
Physician Law Current news, updates, & useful tips relating to legal issues affecting physicians & non-institutional providers in their personal & professional lives

Tag Archives: fraud

Does Your Group Practice Income Division Formula Comply with Stark

Posted in Ancillary Services, Fraud and Abuse

Many physicians I speak with are still surprised to learn that the federal Stark statute imposes restrictions on income division within group practices.  These restrictions only apply to profits generated from any of the Stark “designated health services” and only those that are covered by Medicare and Medicaid (including managed care), but if your group provides… Continue Reading

DOJ Announces Record Fraud Settlement Against Physician

Posted in Fraud and Abuse, Medicare

Yesterday the U.S. Department of Justice announced that it has entered into a $26M False Claims settlement with a dermatologist in Florida.  According to the DOJ, this is one of the largest False Claims settlements against an individual in history.  The physician was accused of allegedly accepting kickbacks from a pathology lab and billing for medically… Continue Reading

Feds Announce Largest Single Physician Medicare Fraud Bust

Posted in Fraud and Abuse, Medicare

I have been speaking with physicians for years about the importance of developing effective fraud and abuse compliance programs in their practices and I often still get the same response:  The government is only interested in the big fish like pharmaceutical manufacturers and hospitals -physicians are under the radar.  Well, contrary to popular belief, it appears that there… Continue Reading

Fizzle But Not Much Bang: Medicare Fraud Prevention System Early Results Not Great

Posted in Fraud and Abuse, Medicare

In June of 2011, I reported on this blog about a software program being launched by the federal Department of Health and Human Services to use a technology called predictive modeling to identify fraudulent and abusive billing practices on a prepayment basis.  The program, known as the Fraud Prevention System, was funded through the The… Continue Reading

Federal Prosecutors Continue Focus On Health Care Fraud

Posted in Fraud and Abuse, Medicare

Federal prosecutors continue to focus their efforts on preventing health care fraud, as evidenced by a recent case arising in Texas. Earlier this year, a Houston doctor (Dr. Christina Clardy) was convicted of three counts of mail fraud, 14 counts of health care fraud and one count of conspiracy to commit health care fraud – all relating to over $45 million in false billings to Medicare and Texas’ Medicaid programs.

Another Proposed Physician Joint Venture Bites the Dust

Posted in Fraud and Abuse, Medicare

Physicians are feeling the economic burn of the down economy perhaps more than the average American. Not surprisingly, creative physician joint ventures are proliferating in the healthcare industry as a means of stabilizing revenue streams and referral patterns. Unfortunately, many of these arrangements may raise questions under applicable fraud and abuse laws. One such proposed… Continue Reading

HHS to Employ “Predictive Modeling” to Identify Fraud and Abuse

Posted in Fraud and Abuse, Medicare

Kathleen Sebelius, Secretary of the Department of Human Services, recently announced during a press conference that HHS will as of July 1, 2011 be rolling out a $77 million computer program designed to prospectively identify potentially fraudulent Medicare claims by collecting and analyzing patterns in large numbers of submitted claims. According to a recent article in… Continue Reading

HHS Secretary Sebelius Talks Fraud, Payment Reform At Summit

Posted in Fraud and Abuse

  HHS Secretary Kathleen Sebelius addressed the New York Health Care Fraud Prevention Summit on November 5 in Brooklyn and updated attendees on the government’s efforts to rein in health care fraud. Significantly, she also indicated that CMS intends to squeeze out some of the excessive profit that is currently available to certain suppliers under Medicare. Her… Continue Reading

OIG Publishes Physician Compliance “Roadmap”

Posted in Fraud and Abuse

Responding to input from medical school deans and residency program directors in a recent survey, the OIG has published a plain-English compliance summary for new physicians entitled Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud and Abuse.  This 31-page document covers the following topics in a manner designed to educate new physicians in the basics of… Continue Reading

Wall Street Journal Article Criticizes Confidentiality of Medicare Physician Database

Posted in Fraud and Abuse, Medicare

The recently enacted health reform law has ignited a great deal of public interest in rising health care costs and the underlying reasons for them.  Not surprisingly, fraud, waste and abuse in the system is a recurring theme.   Although of late the third party insurance companies and "corporate fatcats" have drawn most of the criticism in these… Continue Reading

DOJ Announces Massive Health Care Fraud Crackdown

Posted in Fraud and Abuse, Medicare

As further indication that health care fraud enforcement efforts are heating up in a big way, on Friday July 16, 2010, the Department of Justice announced the largest health care fraud crackdown in history.  According to Attorney General Eric Holder, raids were simultaneously conducted in multiple states including New York, Florida, Louisiana and Detroit.  The crackdown… Continue Reading

OIG Blesses Physician On-Call Compensation Arrangement

Posted in Fraud and Abuse, Medicare

In its recent Advisory Opinion No. 09-05, the OIG reviewed a proposed arrangement whereby a hospital would compensate physicians for on-call services performed on behalf of the hospital’s uninsured patients. The OIG concluded that while the Proposed Arrangement could potentially generate prohibited remuneration under the anti-kickback statute, if the requisite intent to induce or reward referrals… Continue Reading

Local Podiatrist Gets Sentenced in Medicare Fraud Case

Posted in Fraud and Abuse, Medicare, Practice Management

Major Medicare fraud and false claims settlements against large providers and pharmaceutical and device companies are reported in the news on a regular basis these days.  Unfortunately this trend may lead many physicians to believe that their billing and collection activities are under the radar of federal and state enforcement authorities.  According to an article in the Scranton Times-Tribune, when it comes… Continue Reading

Pennsylvania Qui Tam Case Highlights Dangers in Physician/Hospital Arrangements

Posted in Fraud and Abuse, Medicare, Physician Compensation

A recent whistleblower case out of the federal 3rd Circuit in Pennsylvania highlights some of the dangers in not properly documenting financial relationships between physicians and hospitals. Specifically, in US ex. rel. Kosenske v. Carlisle HMA, Inc., a Qui Tam lawsuit brought by the former member of an anesthesia group, the 3rd Circuit Court of… Continue Reading

Altering Medical Records: What Not To Do When Being Audited By Medicare

Posted in Fraud and Abuse, Medicare

Document, document, document! is the cry of health care attorneys and consultants across the Country when asked what physicians can do to protect their practices from fraud and abuse liability.  But what happens if you receive a Medicare audit request and you find out that your documentation isn’t so good or even non-existent?  Many physicians when faced… Continue Reading