Healthcare Compliance Perspective:
The submission of a false claim based on services not rendered to a patient would also involve the theft of that resident’s identity, as patients’ names, insurance information, and medical data would be used to fraudulently submit for reimbursement.
A suburban Chicago physician has been indicted on federal fraud charges for allegedly pocketing nearly $1 million in false claim payments from Medicare and a private insurer for nonexistent treatment.
The physician owned and operated a medical care center, and the 12-count indictment alleges that he submitted fraudulent claims for purported medical tests and examinations that were never performed. He allegedly used some of his patients’ names without their knowledge to submit fraudulent claims. From 2008 to 2013, the doctor fraudulently obtained, or caused his clinic to obtain, at least $950,000 in payments from Medicare and Blue Cross and Blue Shield of Illinois, the indictment states.
The indictment was returned Thursday in Chicago’s U.S. District Court. It charges the doctor with seven counts of healthcare fraud, three counts of making false statements in relation to a healthcare matter and two counts of aggravated identity theft. Arraignment is set for May 15, 2018 before a U.S. District Judge.
The indictment describes several instances in which the doctor submitted a claim to BCBS or Medicare for a non-invasive “duplex scan” purportedly performed on a patient, when no such test was performed. On at least one occasion, it is charged that the doctor prepared a seven-page electronic medical record indicating that a patient had come to the office for a follow-up visit and examination, when the patient had only come into the office to re-fill a prescription.
Aggravated identity theft is punishable by a mandatory sentence of two years in prison. Health care fraud is punishable by up to ten years, while false statements carry a maximum of five years. If convicted, the Court must impose a reasonable sentence under federal statutes and the advisory United States Sentencing Guidelines.
