Healthcare Compliance Perspective:
Excluded providers shall not participate in federally funded health care programs and employers must not bill for services rendered by excluded providers. Compliance Officers must check the list of excluded individuals and entities to protect their providers from committing fraud.
ATLANTA -An Atlanta-based pain management clinic, and its owner have agreed to pay the United States $250,000 to resolve allegations that they violated Medicare rules and the False Claims Act (FCA) by billing the Government for: (1) services performed by a physician suspended from the Medicare program, and (2) the administration of foreign, non-FDA approved drugs, which are not eligible for reimbursement under the Medicare program.
Besides the fraudulent aspects involved, providing foreign, non-FDA approved drugs to patients and then billing the Medicare program for those services defiles the basic trust that is accorded to professional healthcare providers. Both the clinic and the owner were aware that a physician they were using had been suspended from the Medicare program related to his previous criminal history. Consequently, all of the services this physician provided were not eligible for Medicare reimbursement. To get around that, the clinic and the owner submitted those claims as having been performed by a different clinic physician who was authorized to participate in the Medicare program.
