Healthcare Compliance Perspective:
Compliance Perspective: False claims and billing fraud may take a variety of different forms, including but not limited to, billing for the same service more than once, submitting claims for services that were not provided as claimed or providing false statements supporting claims for payments.
U.S. and Indiana state attorneys announced recently the filing of a civil Medicaid fraud complaint against two former Indiana physicians and their business entities for filing false claims.
During 2011-2013, the husband-wife physicians practiced medicine together at their own medical facility. They routinely required patients seeking a prescription for opioid pills or other pain medicine to submit a urine sample for qualitative testing for the presence or absence of nine or more drugs or drug classes. Using a simple, multiplexed screening kit costing them less than $5.00, the defendants tested each single urine sample for the same patient on the same day using the simple kit. Afterwards, they billed Indiana Medicaid and received $171.27 per patient, even though Indiana Medicaid billing rules only allowed them to bill $20.83 per patient.
The defendants concealed their fraudulent activity by falsely certifying to Indiana Medicaid that they had collected and separately analyzed nine or more urine samples from each patient, when in fact they only had collected and analyzed one urine sample. The two former doctors perpetrated this fraudulent scheme for over 6,400 claims, and received a total overpayment from Indiana Medicaid of over $1.1 million.
In connection with a state criminal investigation of their opioid-prescribing practices that resulted in one of the doctors being convicted of felony drug dealing, both physicians permanently surrendered their licenses to prescribe drugs and to practice medicine in 2013.
The federal False Claims Act, and the Indiana Medicaid False Claims Act, allows the federal government and the State of Indiana to recover three times the amount of the false and fraudulent claims submitted to Indiana Medicaid plus a civil penalty of $5,500 to $11,000 per false claim submitted. A small portion of recoveries under the federal False Claims Act, three percent, is used to fund the cost of future health care fraud investigations and cases.
