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Tracy Green
1,633 followers
1,633 followers
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Medicare now claims that personal injury attorneys who do not reimburse the U.S. for Medicare payments can be liable under the False Claims Act. This settlement should serve as a warning to attorneys handling these type of liens in settlements. The same with Medicaid or Medi-Cal.

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A recent sentencing shows a long 10 year sentence imposed on a radiologist charged and convicted of federal offenses relating to alleged workers' compensation insurance fraud and illegal kickbacks.

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A 78 year old physician is sentenced to 42 months after getting involved in a compounding pharmacy. Physicians and other professionals need to be careful when getting involved with others in businesses especially when they are older, part-time or young and inexperienced.

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On May 22, 2018, five people linked to two Los Angeles (San Fernando Valley) clinics were arrested on federal health care fraud charges for allegedly inducing patients to visit the clinics with promises of "free" cosmetic procedures, using the patients' insurance information to submit fraudulent claims to at least eight health insurance companies and then using some of the fraud proceeds to provide patients with the free cosmetic procedures.

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This is a lengthy sentence for a plea agreement. This was a California doctor who allegedly also wrote prescriptions for Oregon patients who sold the prescribed drugs and acted as drug traffickers. The federal judge certainly wanted to deter and send a message to other physicians.

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In an unusual and sad case, a former DOJ attorney is sentenced for using confidential information and documents in private practice and then for destroying records after he was arrested.

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Which cosmetic procedures can be billed as medically necessary meeting ICD-9 Codes? A recent criminal case alleges fraudulent billing for such services...as always, Indictments are not evidence and there is the presumption of evidence. But these cases are reminders to dermatologists, plastic surgeons, physicians and nurses to be mindful of the reimbursement rules.
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