Healthcare Compliance Perspective:
If sidestepping standard medical procedures to boost profits result in substandard care, claims for reimbursement may constitute fraud.
The former president of the Harris County Medical Society in Houston, Texas and others entered into an agreement to pay $1,575,000 to settle allegations of Medicare fraud.
An endoscopy nurse formerly employed by a Houston hospital’s surgical center blew the whistle. She alleged that the former medical society president and other physicians who performed colonoscopies at the hospital where she worked, failed to meet established medical standards. A standard colonoscopy takes between 20 minutes and an hour. She claimed he procedures were done in 2 minutes, on average, and were essentially worthless. She alleged the risk of precancerous lesions could be missed, colonoscopies took as little as two minutes, and sanitation guidelines were avoided. She also claimed that she was fired the day after she complained to corporate officers.
