12/19/2013    Steven J. Kaniadakis, DPM

MI Podiatrist Vows to Fight Medicare Fraud Charges

I speak from experience. Join a consultant group
or organization which shall guarantee to act on
your defense including trial defense experts.
Dictate that you prepped and anesthetized the toe,
or DPM experts will say, "I see no evidence that
the procedure (code number inserted here) was
performed."

Do not relay upon blaming your "girl" up front, or
even blaming what you were thinking was the very
best billing and coding company that you hired.
You, doctor, are considered the "leader and
organizer" in the billing scheme and responsible
for each and every billing and/or coding submitted
or placed in the U.S. mail.

Many physicians and podiatrists do not realize
that even so called, down (under) coding or
billing for services are subjected to by coding
experts as illegal, and even when you don not get
paid, it can be considered "attempted fraud". Do
not think that so called "risks of errors and
omissions" insurance shall hold you immune. Since,
this excludes intended acts. I can assure you that
prosecutors and their DPM experts will say that it
was an intentional act.

Finally, many DPMs reacted thinking that my post
was intended to be a mocking the legal system as
no need to fight the "facts", as the MI DPM
accused, report asserted he cried out, "It's not
founded in fact."

I am being serious. The prosecution tactics
include to lead the defense into what are called
factual disputes, the factual case, opposed to the
legal case. For example, unbundling act might be a
factual dispute, about what's included in a global
bundle or package (coding matters). Whereas, the
legal dispute is health care fraud, that that is,
did the DPM bill for 'more money than otherwise
entitled to receive' (the legal case). By law, the
latter is the legal case, the legal dispute, for
the judge/jury. Opposed to a prosecution that gets
DPM experts that can be interpreted as make
believe crimes. However, this was not what I meant
by this particular PM News post.

Steven J. Kaniadakis, DPM, St. Petersburg, FL,
stevenkdpm@yahoo.com

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