Jury Finds Georgia Physician Guilty of Medicare and Medicaid Fraud
After a trial that lasted a little over a week, a jury found a physician guilty on seven counts of defrauding Medicaid and Medicare. The doctor, along with a physician’s assistant who worked with him, were indicted for submitting 31,000 claims over a three-year period at four local nursing homes. Many of the claims were for services that were never provided.
The indictment alleged that in one instance the doctor billed for 150 visits supposedly performed in one day. Another similar bill was for 85 visits during a four-day period when records showed the doctor was actually in Las Vegas.
The physician’s assistant pleaded guilty to conspiracy and could face up to 10 years in prison. His plea agreement estimated restitution in the case at more than $2.6 million. He testified for four and one-half hours in the doctor’s trial.
Based on the jury’s verdict that found the doctor guilty of conspiracy to commit healthcare fraud, the doctor faces a maximum penalty of 10 years in prison, a $250,000 fine, or both on each of the seven counts.
Compliance Perspective
Allowing physicians and physician’s assistants to provide services for residents without having completed the nursing home’s required vendor contract and who have been excluded from receiving Medicare and Medicaid reimbursements due to convictions for violating the False Claims Act could result in the nursing home being excluded from Medicare and Medicaid.
Discussion Points:
- Review policies and procedures regarding vendor contracts for physicians and physician’s assistants and the facility’s process for performing background and exclusion checks.
- Train staff to be aware of the care provided by physicians and physician’s assistants to ensure that those services are provided and are medically necessary.
- Periodically audit vendor contracts for physicians and physician’s assistants to ensure that they are complete and that periodic checks are made to ensure that physicians and physician’s assistants have not been excluded from billing Medicare and Medicaid.
