A Michigan doctor pleaded guilty on May 2, 2023, to defrauding Medicare of more than $925,000 in healthcare payments. According to court records, the doctor operated a practice in Dearborn, Michigan. Beginning in January 2015, the doctor was suspended from submitting claims to Medicare for any services that he rendered. However, during his suspension, the doctor continued to treat Medicare beneficiaries, and then he fraudulently submitted claims to Medicare utilizing the names and identification numbers of other doctors, including a co-defendant, in order to receive reimbursement for the services he rendered.
As part of the guilty plea, the doctor agreed to forfeit approximately $367,000 in cash seized by federal agents during the course of the investigation. A sentencing hearing is set for September 14, 2023. The doctor faces up to ten years in federal prison.
“Not only did this provider continue to submit claims to Medicare after being suspended from Federal healthcare programs; he also used his patients’ information to try and steal from those programs,” said Mario M. Pinto, Special Agent in Charge at the US Department of Health and Human Services, Office of Inspector General (HHS-OIG). “HHS-OIG will continue in our efforts to identify and investigate those who violate the privacy and trust of their patients and steal from taxpayers for selfish financial gain.”
Compliance Perspective
Issue
HHS-OIG has the authority to exclude individuals and entities from federally funded healthcare programs for a variety of reasons, including a conviction for Medicare or Medicaid fraud. Those that are excluded can receive no payment from federal healthcare programs for any items or services they furnish, order, or prescribe. OIG maintains a list of all currently excluded individuals and entities called the List of Excluded Individuals/Entities (LEIE). Anyone who hires or partners with an individual or entity on the LEIE may be subject to civil monetary penalties (CMP). To avoid CMP liability, healthcare entities should routinely check the list to ensure that new hires and current employees are not on it.
Discussion Points
- Review your policies and procedures for screening of potential employees to confirm that they are not included on a state or OIG exclusion list. In addition, review your policies and procedures for frequency of checking the OIG Exclusion List for all current employees and vendors. Update policies as necessary.
- Train all appropriate staff on the requirement for checking the OIG LEIE link for all new potential hires, current employees, and vendors, and the frequency for repeating the checks. Document that the trainings occurred and file the signed document in each employee’s education file.
- Periodically audit to ensure that all new employees have been confirmed as not being on the OIG LEIE. Also, determine that routine checks are being conducted for current employees to ensure that they have not been added to the OIG Exclusion List. Ensure that a copy of the OIG LEIE screening confirmation is included in each employee or vendor file.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
