As a healthcare practitioner, permission to work with Medicaid and Medicare participants can be an extremely lucrative area of practice. For many physicians working in areas with an aging or low-income demographic, government healthcare enrollees can quickly become a large majority of the patient load – which can often invite an increased risk of fraud against these two already strained healthcare systems.
In today’s post, we explore a recent settlement [1. Sheppard, Howard, “Hamilton Health Center settles with feds in false claims suit.” May 27, 2015. http://fox43.com/2015/05/27/hamilton-health-center-settles-with-feds-in-false-claims-suit/] out of Harrisburg, Pennsylvania, which serves as a reminder that physician-enrollment in these programs is a privilege, not a right. The government can revoke a doctor’s right to treat covered patients in the event he or she is found to be in non-compliance with regulations.
Details of the allegations against Hamilton Health Center
Hamilton Health Center provides a wide variety of health services ranging from women’s health to dental and employs hundreds of practitioners and health professionals across its Harrisburg campuses. For a period spanning from 2006 through 2013, the center is alleged to have employed and compensated a physician who had been previously barred from participating in the Medicare and Medicaid services, likely due to an egregious violation of program regulations.
As a result of the finding [2. “Hamilton Health Center agrees to settlement of federal civil matter.” May 28, 2015. http://westmorelandtimes.com/news/16514/28/hamilton-health-center-agrees-to-settlement-of-federal-civil-matter/], Hamilton voluntarily disclosed the matter to government investigators, who later settled with the center for $270,000. Oftentimes, self-disclosure and voluntary cooperation with the Department of Health and Human Services will result in a much-reduced penalty – and possibly eliminate the threat of treble damages permissible under the False Claims Act.
The False Claims Act is triggered any time a healthcare facility seeks reimbursement based on fraudulent billing or failure to adhere to guidelines when treating government healthcare beneficiaries. However, the Act also has a definitive intent requirement, meaning any entity facing liability must have intended to act purposefully to commit the fraud. It does not cover mere accidents.
Exclusion from Medicare and Medicaid
Exclusion from the Medicare and Medicaid programs is considered an extraordinary punishment and is not commonly imposed against first-time offenders. This form of punishment is often reserved for healthcare fraud offenders who either commit a series of acts of misconduct, or those that commit an egregious, extensive, or extreme act of healthcare fraud that results in serious injury or death to patients. Exclusion can be permanent, or for a period of years, depending on the nature of the offense. Once a practitioner or entity is deemed ripe for exclusion, an administrative process will ensue, involving both the defendant(s) and the Office of Inspector General. At that time, defendants may file an answer to the OIG’s Notice of Intent to Exclude, which will be taken into consideration by the office. Once excluded, the practitioner or entity is placed on the List of Excluded Individuals/Entities (LEIE), which is available for review by the public.
Contact Berger & Montague, P.C. today
If you are aware of possible fraud or mismanagement at your place of employment, please do not hesitate to contact Berger & Montague, P.C. right away.