Healthcare Compliance Perspective:
Compliance Officers must ensure that the services billed match the services rendered by all personnel, including contracted physicians. If an Explanation of Benefits raises suspicions of possible improper billing under Medicare Part B, the Compliance Officer must immediately notify the Compliance Committee.
JACKSONVILLE, Fla. – A 55-year-old doctor pleaded guilty Monday to one count of health care fraud in a case that involved clipping toenails, according to the U.S. Attorney’s Office. He faces a maximum penalty of 10 years’ imprisonment and must pay mandatory restitution of approximately $1.5 million. A sentencing date has not yet been set.
The podiatrist billed Medicare and TRICARE programs under the guise of “removal of skin and muscle” when all he was really doing was performing routine foot care, including clipping of toenails-a non-reimbursable service. As a result, he received $1,504,952.67 in illegal reimbursements.
Compliance and Ethics Code of Conduct:
It is expected that all personnel and external agents shall act in compliance with the requirements of applicable law and in a sound ethical manner when rendering services to our residents.
