Uncategorized
Dec 31

Physician offices staying out of trouble with the government

A lot of physician healthcare enforcement actions relates to the performance of unnecessary services and when those services put the health and safety of patients at risk.  Most of us would normally think that physicians and health care institutions would not put patients at risk but unfortunately there have been a number of recent high publicity cases that demonstrate that this may not actually be the case.  Last year the Tenet Reading Medical Center in California settled a case with the government in which the hospital, along with its physicians, were alleged to have performed unnecessary cardiac catheterizations on patients in order to bill Medicare, Medicaid and other private insurance carriers. This is a deeply disturbing allegation because cardiac catheterizations inherently involve risk to patients.  Another example of this was an indictment of three physicians in Florida who dispensed HIV medications to patients which were not medically necessary.   Again, these medications can have toxic side effects and so the patients are at risk.

This trend continues.  Recently there was a case of a physician who was charged with the looting of HIV medications.  Physicians need to think how a federal prosecutor or an OIG investigator might organize his or her day.  Generally, these investigators are overworked and they have a stack of cases on their desks.  What is likely to make a case rise to the top of the pile is a situation where the investigator perceives not only financial harm to the government but also physical harm to patients.

One of the things that individual physicians have to realize is that the group practice is going to be liable for the actions of the individuals in the group.  It is no longer sufficient for partners in a medical practice to turn a blind eye to the practices of one of their partners.

About Reed Tinsley, CPA

As a top advisor to physicians, I help increase practice profits by delivering hands-on, expert medical accounting/tax support, practice counsel, and revenue-building strategies. Read more →