A federal grand jury in Memphis, Tennessee, returned an indictment charging a podiatrist with a scheme to defraud Medicare and TennCare by prescribing and dispensing medically unnecessary foot bath medications.
According to the indictment, the Tennessee podiatrist owned and operated a podiatry clinic, as well as multiple in-house pharmacies. The indictment alleges that he regularly prescribed antibiotic and antifungal drugs to be mixed into a tub of warm water for patients to soak their feet. These drug cocktails included capsules, creams, and powders that were not indicated to be dissolved in water and some of which were not water soluble.
The indictment alleges that the Tennessee podiatrist chose these medications to prescribe and dispense based on their anticipated reimbursement amount, rather than medical necessity. For example, in 2019, he wrote a prescription to a patient for 1,080 capsules of vancomycin, 7,650 grams of econazole cream, and 180 grams of lidocaine, all to be dissolved in a foot bath, and caused Medicare to reimburse his pharmacy over $18,000 for dispensing these drugs. From approximately October 2018 to the present, he allegedly caused his pharmacies to submit nearly $4 million in claims to Medicare and TennCare for dispensing expensive foot bath medications that were not medically necessary and would not have been eligible for reimbursement.
The Tennessee podiatrist is charged with five counts of healthcare fraud. If convicted, he faces a maximum penalty of 10 years in prison per count. A federal district court judge in the Western District of Tennessee will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.
HHS-OIG and the Tennessee Bureau of Investigation are reviewing the case. An indictment is merely an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.
Since its inception in March 2007, the Health Care Fraud Strike Force, which maintains 15 strike forces operating in 24 federal districts, has charged more than 4,600 defendants who have collectively billed federal healthcare programs and private insurers for approximately $23 billion. In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
Compliance Perspective
Issue
Nursing facilities are required to provide podiatry services to their residents as needed. A signed contract by both parties must be on file with expectations of the podiatrist listed within the contract. Podiatrists should be billing for Medicare and Medicaid services through their own billing departments. Nursing facilities should not submit duplicate billing to Medicare or Medicaid for these services, which could result in a false claim. Ensure that all staff are aware that these violations can occur whether they are intentional or not intentional. Failure to promptly report a false claim can result in lawsuits, fines, and other sanctions. Additional information is available in the Med-Net Corporate Compliance and Ethics Manual, Chapter 1, Compliance and Ethics Program, CP 2.3 General Legal Duties and Antitrust Laws.
Discussion Points
- Review all contracts for vendor services and ensure that information for billing practices is included in each contract. Update contracts as needed.
- Train appropriate staff on facility billing practices. Document that these trainings occurred and file each signed document in employee’s education file.
- Periodically audit to ensure that contracted services are being billed appropriately and that there are current contracts in place.
FOR MORE INFORMATION ON THIS TOPIC VIEW: FRAUD MODULE 3 – MASTERING LEGAL IMPLICATIONS AND ANTITRUST LAWS.
