Healthcare Compliance Perspective:
The Compliance Officer is responsible for developing and maintaining all compliance-related policies and procedures. Periodic audits should be done to ensure that the services billed by outside medical providers have actually been performed.
An Oklahoma physician has agreed to pay $580,000 to settle civil claims stemming from allegations that he violated the False Claims Act by submitting false claims to the Medicare program, announced a United States Attorney for the Western District of Oklahoma.
The doctor is licensed in the State of Oklahoma and is a former owner and employee of two limited liability podiatry clinics which later 
were given a different name.
The United States alleges that the doctor caused false claims to be submitted to the Medicare Program for services he did not provide or supervise. First, the United States alleges that in 2011, he allowed a clinic to use his National Provider Identifier numbers (NPIs) to bill Medicare for evaluation and management physical therapy services that he did not provide or supervise. Second, the United States alleges that in December 2011, he separated from that clinic and no longer provided any additional services for the clinic. He also deactivated his NPIs associated with that clinic. However, he reactivated his NPIs associated with the clinic around March 2012; so, the clinic could use them to bill Medicare for services in January and February 2012 that he did not perform or supervise.
To resolve these allegations, the doctor agreed to pay $580,000. In reaching this settlement, he did not admit liability, and the government did not make any concessions about the legitimacy of the claims. The agreement allows the parties to avoid the delay, expense, inconvenience, and uncertainty involved in litigating the case.
This case was investigated by the United States Department of Health and Human Services, Office of Inspector General, and the Federal Bureau of Investigation. Assistant United States Attorneys Scott Maule and Ronald R. Gallegos prosecuted the case.
(Department of Justice U.S. Attorney’s Office, Western District of Oklahoma)
