Healthcare Compliance Perspective:
It is the obligation of the employee to alert The Compliance Officer of any exclusion from participating in any state or federal healthcare program. Furthermore, it is the responsibility of the Compliance Officer to periodically review the OIG Exclusion Database to check for excluded employees and third party vendors.
Earlier this month, a 61-year-old physician of Missouri entered into a plea agreement and pled guilty to one felony charge for making false claims to a health care benefit program. The doctor acknowledged that her license to practice medicine had been suspended in June 2013 because she neglected to pay her state taxes. The doctor’s license ultimately expired at the end of January 2014. However, 
after April 2016, she continued to submit numerous office visit claims for reimbursement to health care benefit programs regarding Missouri patients even though she had neither an office nor a medical license with which to provide medical services until January 30, 2017.
The estimated loss from these fake claims to the various healthcare benefit programs was calculated at $304,843. The maximum penalty for making false statements is a maximum of five years in prison and/or as much as $250,000. However, “a judge is required to consider the U.S. Sentencing Guidelines” when deciding on the actual penalty. The doctor will be sentenced in February 2018.
