Medical Practice Management, Uncategorized
Nov 27

Physicians acting badly

A number of physicians were recently indicted, convicted and sentenced for healthcare crimes. Here are a few examples. Remember this government is actively working to identify and prosecute physicians who participate in or devise illegal kickback schemes.

A Texas physician recently was sentenced to prison following his conviction of conspiracy to commit health care fraud relating to medically unnecessary diagnostic testing and physical therapy. These unnecessary services were billed to Medicare and Medicaid for payment under the physician's billing number. The physician worked in conjunction with the owners and operators of medical clinics and diagnostic testing centers in the Houston area.  As part of the scheme, Medicare patients were paid to show up at the clinics for testing. Patient recruiters also were paid for recruiting and bringing patients to the clinics for the unneeded testing. Another Texas physician was sentenced to 48 months in prison for health care fraud.

From early 2009 through 2011, Orange MRI paid physicians for each MRI and CT scan they referred. One physician reported that Orange MRI gave him $100 cash for each Medicare or Medicaid patient he referred for an MRI and $50 for each CT scan referral.  As a result of these relatively small payments, 12 physicians and nurse practitioners either have been convicted or have pled guilty to receiving kickbacks.

Physicians were recently indicted in connection with kickbacks paid by Sacred Heart Hospital in Chicago in exchange for the referral of hospital patients covered by Medicare and Medicaid. According to the indictment, Sacred Heart paid physicians bribes concealed as consulting, employment and personal services compensation, rent and instructional stipends from 2004 through 2013.

Another physician employed as the medical director at Home Care Hospice Inc. (HCH) was sentenced to 51 months of prison time for receiving kickbacks for patient referrals. The physician entered into a written contract that attempted to camouflage kickbacks as payments for services rendered in the physician's capacity as medical director. The large majority of payments, according to the government, were illegal payments for the referral of Medicare and/or Medicaid patients to HCH.

A Garland, Texas, physician pled guilty to conspiracy to commit health care fraud in connection with a physician house call company's billing Medicare for care plan oversight for numerous beneficiaries when the physician was out of town, including dates when he was out of the country and on a cruise. The company submitted claims to Medicare using Dr. Padron's unique Medicare number, with Padron's permission, regardless of the claim's merit.

Finally not to be outdone, a Kenner, La., physician pled guilty to 35 counts of Medicaid fraud for billing Medicaid for services, such as tests, procedures and treatments not rendered and knowingly falsifying documents to support the fraudulent billing of those services. To complete the fraud, the physician also recorded bogus diagnoses and symptoms to justify his billing.

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 →