A Pennsylvania psychiatrist and his wife have agreed to pay $3 million to resolve alleged violations of the False Claims Act. The alleged violations include submitting false billing to the US Department of Labor Office of Worker’s Compensation Programs (OWCP) for psychiatric services that were not provided, and for upcoding and double-billing patient claims. The psychiatrist’s wife was his office assistant and sole employee. In addition to the monetary fines, the psychiatrist and his wife will be voluntarily excluded from federal healthcare programs for 25 years. This is the largest recovery against a single psychiatrist in the history of the OWCP.
An attorney had referred patients who were receiving federal workers’ compensation benefits to the psychiatrist. These benefits were authorized under the Federal Employees Compensation Act. Many of the patients were receiving OWCP benefits because of a physical injury. They were later approved for mental health services that were purportedly needed because of their initial physical injury.
A multi-agency investigation revealed that from January 2013 through April 2021, the psychiatrist and his wife allegedly billed for services that were not rendered. Some of these billed services occurred at times when the two were outside of the United States. Additionally, they allegedly billed for cancelled and no-show appointments as if they had actually occurred, and upcoded or billed for a higher level of service than what was actually provided, including billing for more therapy time than what was spent with the patient. They also double-billed the patient and OWCP for initial consultations. The psychiatrist allegedly falsified treatment records to reflect the false billing that was submitted.
Special Agent in Charge Christopher Algieri of the Department of Veterans Affairs Office of Inspector General’s Northeast Field Office stated, “Fraudulent healthcare billing practices compromise the federal government’s ability to provide quality benefits to deserving individuals.”
Compliance Perspective
Issue
All staff should be knowledgeable of what constitutes a false claim and that false claims can be generated in a variety of capacities. Staff should also be aware that false claims and kickbacks can occur whether they are intentional or unintentional. Failure to promptly report a false claim or kickback can result in lawsuits, fines, and other sanctions. An effective compliance and ethics program can reduce fraud, waste, and abuse of government funds. It can also prevent and detect criminal, civil, and administrative violations, including false claims and kickbacks, and promote quality of care.
Discussion Points
- Review your policies and procedures for operating an effective compliance and ethics program to ensure that identifying and reporting of false claims or kickbacks is included. Ensure that your policies are reviewed at least annually and updated when new information becomes available.
- Train all staff on your compliance and ethics policies and procedures upon hire and at least annually. Additionally train all staff on what can be considered a false claim or a kickback. Document that these trainings occurred and file the signed document in each employee’s education file.
- Periodically perform audits to ensure all staff are aware of their responsibility to identify and report compliance and ethics concerns and understand that it is their responsibility to report violations to their supervisor, the compliance officer, or via the anonymous hotline in a timely manner.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
