Anthony Enrico, a Passaic County Podiatrist, was sentenced to three years in prison for unlawful billing of Medicare totaling $3 million dollars.
Over the course of a ten-year span, Enrico employed several uncertified and unlicensed staff members in his three offices in Paterson, Passaic, and Elizabeth NJ. During this time, there were 150,000 instances of unlicensed individuals billing for services. All billed services must be performed by licensed professionals such as Enrico. To do otherwise is considered fraudulent.
Under the FCA (False Claims Act), common improper claims include billing for services not rendered, billing of services that were low quality/worthless, and billing for services not medically necessary. The FCA also deems billing of procedures done by unqualified employees as fraudulent.
Care providers must be keenly aware of what constitutes fraud and what does not when billing for services. Services should be medically necessary, of high quality, and of course be provided by licensed and certified employees.
Not only should all services be provided by licensed and qualified employe
es, but employers should make sure employees are not on the OIG exclusion list. If employees are found to have committed resident abuse, for example, they could be placed on the exclusion list. Such a case could expose the employer to accusations of fraud, since services provided by excluded employees does not qualify as acceptable for billing.
Sources
https://www.bafirm.com/publication/fraudulent-medical-billing-and-the-false-claims-act/
