In today’s post, we will explore a recent $105,000 settlement involving a Tulsa, Oklahoma, physician accused of defrauding the taxpayer-funded Medicare system, which serves millions of Americans aged 65 and older with affordable health insurance coverage.[1. Department of Justice Press Release, “Settlement Reached In Medicare Fraud Lawsuit Against Tulsa Doctor And His Medical Clinic.” June 11, 2015. http://www.justice.gov/usao/okn/news/2015/blocksettlement0611.html]
Under the False Claims Act, a practitioner may face significant fines and penalties for submitting invoices on behalf of Medicare patients that are not 100 percent accurate and reflective of the care actually rendered. While the Act does not punish mere accidents or negligent conduct, it has been successful in recovering billions of dollars on behalf of Americans at the hands of healthcare practitioners and entities engaging in the intentional and purposeful theft of funds from programs like Medicare, Medicaid, and TRICARE.
Details of the allegations against Integrations Medical Clinic
Licensed and board-certified physicians are the keystone of a safe and effective patient experience. Nonetheless, one of the most common offenses occurring under the auspices of the False Claims Act is the utilization of under-qualified nursing or support staff members in the patient care process, which is considered a serious violation of Medicare and Medicaid regulation.
In some cases, Medicare and Medicaid guidelines allow practitioners to utilize nurses and support staff to perform routine, perfunctory procedures on patients, which must be billed at a much-reduced rate than that of the doctor. However, the doctor must maintain constant supervision over the activities of his or her staff and must stay up-to-date with the advancements and changes in a patient’s medical history.
In this case, Dr. Jerome E. Block, M.D. of Integrations Medical Clinic is accused of charging Medicare physician rates for patient services while, in reality, nurses and staff members were engaging in the patient evaluation and management visits – oftentimes without adequate supervision. More specifically, the doctor is alleged to have billed for his time spent conducting the following activities, which were actually conducted by staff:
-Evaluating and recording new patients’ medical history
-Interacting with the patient to determine his or her chief medical complaint and history of present illness
-Performing physical examinations
-Making decisions regarding patient care plans
-Recording medical decision making
The relator in this case, who was a former employee of Dr. Block, is expected to receive $28,350.00 as a reward for his involvement in the case. According to a statement by the U.S. Attorney’s Office, “This settlement demonstrates the U.S. Attorney’s Office’s commitment to combating healthcare fraud. We will investigate and prosecute violators and those who abuse the system….We are dedicated to protecting taxpayer money and the integrity of Medicare. When healthcare providers try to increase their profits by misrepresenting the services they bill to taxpayer-funded healthcare programs, we will do our best to make sure that they are held accountable.”
Contact Berger & Montague, P.C. today
If you are aware of possible healthcare fraud relating to Medicare or Medicaid patients, please do not hesitate to contact Berger & Montague, P.C. right away to report your information. In many instances, relators can receive up to 30 percent of the ultimate settlement or recovery amount.