A Tennessee physician, who operated as a consulting provider for a Florida-based telehealth and marketing company and a physician staffing company located in Georgia, faces federal charges for his role in a $7 million healthcare fraud conspiracy.
Part of the conspiracy involved unsigned orders and prescriptions for Durable Medical Equipment (DME), which the doctor received from these companies and others. He signed the orders and prescriptions in the absence of any pre-existing doctor-patient relationship and without a physical examination as required by Medicare. The charges also allege that the accused doctor frequently signed orders and prescriptions based only on a brief telephone conversation or no conversation at all with the Medicare beneficiary. In other instances, he had an unlicensed assistant sign his name and paid this individual cash for each prescription signed. The doctor also signed orders and prescriptions for patients located in states where he was not licensed.
From February 2015 through August 2019, the physician and others are alleged to have caused the submission of approximately $7 million in false and fraudulent claims to Medicare. The prescribed DME was not medically necessary, was not provided as represented, and not eligible for reimbursement because the orders and prescriptions were procured through the payment of kickbacks and bribes. The charging information also contains a forfeiture allegation in the amount of $493,780.00-the amount the doctor received in kickbacks resulting from the scheme.
The accused doctor made his initial appearance before a U.S. Magistrate Judge and was released with certain conditions, including his not being allowed to practice medicine.
If convicted, the doctor faces up to 10 years in prison and a $250,000 fine.
Compliance Perspective
Allowing a physician, without any doctor-patient relationship to residents and without performing a physical examination as required by Medicare, to prescribe unnecessary durable medical equipment, submit false claims for reimbursement to Medicare, and receive kickbacks related to those prescriptions may be considered a violation of the Anti-Kickback Statute and False Claims Act and deemed provision of substandard quality of care, in violation of state and federal regulations.
Discussion Points
- Review policies and procedures for screening physicians who supervise the care of residents to ensure that they are not disqualified as Medicare providers for any cause.
- Train staff regarding the need to perform background and Medicare exclusion checks on physicians who care for residents in the facility.
- Periodically audit the status of the facility’s physicians to ensure they receive regular background and OIG exclusion checks.
FOR MORE INFORMATION ON THIS TOPIC: STAYING ON TOP OF EMPLOYEE CHECKS
