Law Offices of Jeffrey C. Grass Articles Texas Doctor Charged with Medicare Fraud

Texas Doctor Charged with Medicare Fraud

Nov. 8, 2012 3:06p

Texas Doctor Charged with Medicare Fraud

Federal law enforcement officials have arrested a Texas doctor and charged him with health care fraud and conspiracy to commit health care fraud. A second doctor has also been named, but has yet to be apprehended and is presumed to be on the run from the law.

The doctors are charged with defrauding the federal Medicare program that provides medical care to seniors and other individuals who meet certain conditions. The arrest was the result of an investigation by the Federal Bureau of Investigation, the Texas Attorney General's Medicaid Fraud Control Unit, the Office of Investigations and the Department of Health and Human Services-Office of the Inspector General. The concerted efforts of these various law enforcement agencies to identify billing irregularities exemplifies how seriously the government takes health care fraud and how seriously problems can become if doctors are not precise in their billing practices.

Sticky Fingers or Sticky Computer Keys?

The doctor in custody is accused of falsifying his Medicare and Medicaid billing records, cumulating in $850,000 of charges to the federal programs. The complaint alleges the doctor received $390,000 due to the inaccurate billing practices.

The man faces 13 counts of fraud, each carrying penalties of up to 10 years in federal prison and fines up to $250,000. The doctor has pleaded not guilty to the charges.

On the surface, it may not be surprising that the doctor's billing attracted attention. The investigation uncovered one Medicare patient had over 800 inner ear tests billed to his or her Medicare account on 161 different days, while other patients had 500 or more inner ear tests billed to their Medicare accounts.

The volume of billings alone begs the question, why would anyone intending to commit Medicare and Medicaid fraud be so blatant? Given the high probability of getting caught, it doesn't seem likely. Could there be another reason?

Perhaps there is. Given the complexity of tax forms alone, in shouldn't be surprising to many that the government has created a confusing and challenging process for submitting Medicare and Medicaid claims. The process is so difficult, that billing errors are quite common. These simple mistakes are what often lead to charges of Medicaid fraud.

Avoid These Common Medicare Billing Errors

Unfortunately, billing errors will always occur because doctors are human and make mistakes. It is possible, however, to avoid the common billing errors that slow down the Medicare billing process and may inadvertently put a doctor on the wrong side of the law.

The Center for Medicare and Medicaid Services (CMS) maintains a list of common Medicare billing errors for physicians to refer to as they bill Medicare for services rendered to Medicare recipients. One of the more common errors physicians make is failing to record a patient's Medicare identification number. This is known as the Health Insurance Claim Number and is found on the patient's Medicare ID card.

Other errors concern missing or incomplete information. Some doctors forget to include the referring physician's name when preparing Medicare billing records. Others fail to fully record the place where the patient was treated. Medicare does not accept forms that simply list "SAME" as the location, even if the service was performed at the doctor's office already listed on the form.

Still more mistakes include billing code errors similar to those at the heart of the Texas doctor's recent arrest. Sometimes, doctors use incorrect diagnosis codes on billing reports or use a code that does not exist by adding or deleting a number. Doctors also may fail to double-check their evaluation and management procedure codes to make sure they match the place of service. For example, a physician may fail to catch that they have recorded that an emergency room visit occurred at an office place of service rather than emergency room.

To ensure they are submitting accurate reports and avoiding possible legal action, physicians should always double-check their forms to identify errors prior to submitting the form to the government. If you have been accused of Medicare fraud due to a mistake you made on a Medicare billing form, please contact an experienced Dallas criminal defense lawyer.

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