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03/09/2023
RESPONSES/COMMENTS (PODIATRISTS AND THE LAW)
RE: MI Podiatrist Sentenced for Billing Medicare $1.8M Under False Identity
From: Lawrence Rubin, DPM
The May 8th issue of PM News contained two more published reports about podiatrists who have committed insurance fraud. Regular readers have been seeing an upsurge in these punitive actions. For various reasons, every podiatric practice billing insurance, and particularly Medicare and Medicaid, is now under high risk of audits and potential adverse consequences.
Forewarned should be forearmed. For many years, the Federal Office of the Inspector General (OIG) has recommended that solo and small group practice physicians implement its insurance billing compliance programs for providers and staff. The OIG recognizes that not all aberrant billing is intentional and the fault of the provider. In fact, the OIG states that having a compliance plan in place is a "mitigating factor against punitive action."
It is sad that the vast majority of honest podiatrists have to go through audits to literally prove their honesty, but that is the reality we face. Having an OIG recommended practice compliance program in action when an audit occurs should be a standard operational practice in today's regulated insurance reimbursement environment.
Lawrence Rubin, DPM, Las Vegas, NV
Other messages in this thread:
05/10/2023
RESPONSES/COMMENTS (PODIATRISTS AND THE LAW) - PART 1B
From: Paul Kesselman, DPM
Yes, it is indeed sad that we see our own being indicted and then convicted of third-party insurance fraud. However, the OIG and CMS are usually notified to investigate practitioners when they are suspected of egregious billing practices and errors. There are far more who are civilly punished and have to pay back what still are hefty sums of money without having to serve prison time nor do they make the OIG or lay press publications. It is for this reason that practices, in particular solo or small group practices, need to invest time and money into compliance packages and programs. This is to allow them to keep the hard earned money and to prevent escalation to OIG investigations.
CMS and all third-party payers know that the large groups have healthcare attorneys and teams who keep these practices on the straight and narrow. Otherwise, due to the large amount of...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
05/10/2023
RESPONSES/COMMENTS (PODIATRISTS AND THE LAW) - PART 1A
From: Michael Rose, DPM
I strongly concur with Dr. Rubin’s recommendation for an audit system for claims in your practice. In addition, it is possible to set up a photo/history of some key billings. Almost all podiatrists administer care that is uncompensated. Mostly that is a form of basic care that does not have sufficient medical “justification” or is not covered by present rules.
It is possible to photo document those cases, and state in the chart that no charges were made to the patient or Medicare, and none were “authorized.” Then, just tell the patient that their care is not covered, but you “allocate” a certain number of cases/month to uncompensated situations. You can use your cell phone to take pictures of these, and put them on a list.
During an audit, you can show the auditors your uncompensated list, as a part of your in-office documenting and audit process. It is unlikely that they are expecting such a demonstration and will likely be surprised you have it. Your photo documentation creates a difficult enforcement boundary for them.
Michael Rose, DPM, Cleveland, OH
05/01/2023
RESPONSES/COMMENTS (PODIATRISTS AND THE LAW)
From: Michael M. Rosenblatt, DPM
My heart aches when I read about these cases. I am glad that the Editor includes these in his blog. I cannot understand how or why some DPMs would believe that they are not being observed, and that their billings are supposedly private. It is important to say this outright: "A computerized search of your billings for the last 5 years can be obtained by almost any examining authority in as short a time as 20 minutes."
Any pattern of abuse can be identified in about the same length of time. If I were surmising which DPMs get involved in these illegal projects, I would suggest that they are probably NOT members of the APMA and do not read this...
Editor's note: Dr. Rosenblatt's extended-length letter can be read here.
04/20/2023
RESPONSES/COMMENTS (PODIATRISTS AND THE LAW) - PART 1B
From: Ivar E. Roth, DPM, MPH
I keep reading about these huge cases of fraud by some very well-trained podiatrists. What is wrong with these individuals? There is no doubt there are a lot more out there this very minute doing this and further degrading our profession.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
04/20/2023
RESPONSES/COMMENTS (PODIATRISTS AND THE LAW) - PART 1A
From: Elliot Udell, DPM
There is an issue with the way this case is being presented that begs to be addressed. Two issues are being conflated and readers may get the wrong idea about writing for compounded creams. One issue is whether a physician should write prescriptions for creams made by a compounding pharmacy. The other issue is whether the physician convicted of fraud actually saw and evaluated the patients. Both are two distinct issues. In the article, it indicates that the creams were medically unnecessary. Well, they may have been unnecessary not because there was anything wrong with the creams but because the prescribing doctors never saw the patients.
There are many compounded medications that are very helpful and doctors from all medical specialties frequently write for these drugs. If there is a clear indication for them, we should not be dissuaded from appropriately prescribing them but we must base the prescription on clear evidence that they are indicated. This always requires seeing and evaluating the patients.
Elliot Udell, DPM, Hicksville, NY
04/19/2023
RESPONSES/COMMENTS (PODIATRISTS AND THE LAW)
From: Bret Ribotsky, DPM
Once again, it comes as an absolute shock to me from the conscious side of my brain that many podiatrists who hold leadership positions are so blatantly unaware or intentionally committing acts that will place them in jail, tarnish their reputation, and reflect badly on our profession. When I first read the story about Brian Carpenter, in 2019, I was cheering for his acquittal. But obviously the wheels of justice took four years, and he was found guilty.
As Brian is a past board member of ACFAS and a leader on the lecture circuit in our profession, Brian knew better. This must be a huge gut-check to every seminar that has had him as a speaker. As I shared on this forum a few months ago, there continues to be podiatrists lecturing at CPME-approved events who don’t have licenses (and the audience is not told). I can’t believe that nobody is concerned about this. Where did integrity go?
Bret Ribotsky, DPM, Fort Lauderdale, FL
04/11/2023
RESPONSES/COMMENTS (PODIATRISTS AND THE LAW)
From: Michael M. Rosenblatt, DPM
I am shocked and disappointed when I read of yet another DPM who billed for procedures that require a local anesthesia without demonstrating it. All DPMs should KNOW that the authorities constantly research and analyze billings that “fall” out of the mainstream. Such computer billing evaluations are very, very easy to execute. It is absurd for any DPM to consider that they will go unnoticed.
Yet, I read of yet another DPM who was yet again convicted. A number of years ago, Podiatry Management was kind enough to publish an article I wrote on how to defend yourself using cell phones/inexpensive digital cameras to “create records" to defend yourself. This catastrophe was unnecessary. It is terribly sad.
Michael M. Rosenblatt, DPM, Henderson, NV
10/31/2022
RESPONSES/COMMENTS (PODIATRISTS AND THE LAW)
From: Richard I. Polisner, DPM
With my legal and mediation background, I always like "innocent until proven guilty." I do believe that once the allegations are printed, you are guilty without a defense. I don't like that! It's too easy to make false accusations and too hard to defend yourself after. I knew Sol Lipsman 50 years ago and he was certainly one of the good guys. From the age listed, I assume this is the Sol I knew. I hope the news of these accusations are totally unfounded and PM News will someday print a retraction. If they are true, I will be sad for Sol and hope that he is punished as appropriate and receives the help he would then need.
Richard I. Polisner, DPM, Ponte Vedra Beach, FL
10/28/2022
RESPONSES/COMMENTS (PODIATRISTS AND THE LAW)
From: Name Withheld
It is always very sad to read news such as this about anyone, let alone someone in our profession. Let's hope the doctor gets the help he needs. Seeing these stories brings up the question again as to why such negative news should be posted on this forum. Though this type of story is very sad and invasive in one's personal tribulations, it is articles like these that can protect us all against possible false representations this person can portray. Case in point; when I sold my main practice back in 2016, a fellow podiatrist expressed great interest in purchasing my practice. He reached out to me after seeing my classified ad in the practice for sale section I posted in PM News.
He wasn't just making a casual inquiry, he was interested in making the purchase in an expedited way. His terms and timetable for purchase raised a red flag in my mind. After my conversation with this podiatrist, I did some research by way of Google. It didn't take long for me to find his name being associated with an investigation he was part of concerning his office staff. He was later convicted of this crime. I believe the outcome was posted on this forum. Had it not been for public information posted about this perspective buyer, the sale of my practice could have put my staff and patients in a potentially dangerous position.
Name Withheld
12/16/2020
RESPONSES/COMMENTS (PODIATRISTS AND THE LAW)
From: Michael M. Rosenblatt, DPM
Because the practice license of podiatry does not usually include systemic treatment of COVID-19, it would seem improper for podiatrists to advertise their ability to treat it systemically. I follow a lot of information and data online about COVID-19. If I were in practice, I would not attempt to treat it systemically because that would not be included in my licensure. But I am still "interested" in not contracting it because of my old age. A referral to another website for that treatment by a licensed practitioner whose license includes systemic treatment for COVID-19 would seem to be a Constitutionally protected part of "free speech."
The FDA has a very poor history of monitoring their studies. Recently, both Lancet and JAMA had to retract a bogus, fraudulent study on...
Editor's note: Dr. Rosenblatt's extended-length letter can be read here
03/29/2018
RESPONSES/COMMENTS (PODIATRISTS AND THE LAW)
From: Mark Feldman, DPM
3 years for 3 million dollars of fraud ain't enough time. It's despicable.
Mark Feldman, DPM, Aventura, FL
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