Class 10 -Other Cases
According to an article in the Chicago Tribune, “U.S. Says Doctor Billed For 32 Dead Patients,” (November 4, 2000), indictments for health care fraud are not uncommon in U.S. District Court in Chicago, however charges against doctors are rare. This article describes a case involving a Lake Forest cardiologist specializing in home health care for the elderly who was charged in a criminal complaint with healthcare fraud. This doctor, according to the article, allegedly billed Medicare almost $3.2 million from 1995 through July 2000. Of that amount, authorities did not specify how much was suspected of fraud. The charges allege that the doctor billed Medicare for thousands of nonexistent visits to patients at homes, nursing homes and hospitals. Law enforcement sources indicated that the doctor figured many of the elderly patients would be confused or forgetful about his claims of phony services. However, at least 15 of the patients realized the doctor over-billed Medicare after reviewing their monthly Explanation of Benefits forms sent to their homes and they complained to a hot line established by the Wisconsin Physicians Services, which processes Medicare claims in Illinois. The service notified the FBI, which opened the investigation. Among other things, federal authorities essentially allege that they found evidence the doctor billed for services for 32 patients after the patients had died.
Another prosecution issue involves physicians at teaching hospitals (PATH). Eighteen physician practices affiliated with the University of Pittsburgh School of Medicine agreed to pay $17 million to settle charges that they overbilled Medicare and Medicaid between 1990 and 1996. It was the second largest settlement in the 3 – year old PATH probe at the time. The PATH probe looks at how teaching hospitals and physicians on their faculty bill federal health programs. University officials denied any wrongdoing in connection with the charges. In 1995 came the largest audit settlement at that time with the University of Pennsylvania for $30 million. Thomas Jefferson University in 1996 entered into a $12 million settlement with the government.
In March, 1998, 49 of the country’s leading academic medical centers were in various stages of PATH audits. In November, 1997 University of Virginia physicians paid the U.S. Justice Department $8.6 million for overbilling Medicare. As part of the settlement, the doctor’s group have launched compliance programs to ensure proper handling of future Medicare bills.
HCFA administrator (Nancy -Ann DeParle) had said during that time that Medicare is stepping up efforts to address abuse of physician billing number reassignment such as when bills are submitted for care that is not provided or is inappropriate and which the physician knows nothing about.
Some other prosecution examples include: In New York, federal agents nabbed a doctor who was prescribing unnecessary medical equipment and then planted a camera in her office. Equipment company representatives kept calling her, giving her money in exchange for her signature on their orders. Eight people pleaded guilty.
The government claims that they are only after deliberate attempts to bilk the system for large sums. They cite examples such as fraud for billing for up to 26 hours a day and billing while vacationing in Cancun, Mexico.
In 1997, a physician in Boston submitted bills to Medicare for his dermatology services for patients who sought his medical advice solely for weight loss. Since Medicare and insurers pay a minimal amount for weight loss, this physician contrived his bills to Medicare program and insurers for dermatological services which were reimbursable. He was convicted by a federal jury, sentenced to thirty months incarceration followed by three years of supervised release and ordered to pay a criminal fine of $30,000 and restitution of $182,722.
Another example is the Beverly Hills, CA physician indicted in a 20 count indictment for inflating bills and billing for services never performed such as house calls to dead patients. He was the largest biller of doctor home visits in California in 1994.
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