05/10/2023    Paul Kesselman, DPM

MI Podiatrist Sentenced for Billing Medicare $1.8M Under False Identity (Lawrence Rubin, 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 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 claims
submitted make them a huge target for
investigation.

The real target however are the small groups or
individuals who either have no one to guide them,
or who are purposefully and wittingly committing
fraud. Thus CMS often will go after smaller targets
who may not have the resources to fight back, hence
CMS gets a better ROI. For the former investing
time and money in preventative action programs as
Dr. Rubin suggests, is well worthwhile. For those
who willfully want to skirt or break the law, CMS
and OIGs computers and analysts are far superior
and smarter than you. You will eventually be
caught!

Unfortunately, it is the honest practitioners who
must pay the price for all of this with the
numerous endless types of audits from pre-
payment/TPE to UPIC, ZPIC, OIG and RAC. OIG and
CMS have targeted every entity which takes Federal
payments both inside and outside of healthcare
programs.

Within the healthcare realm, every genre of medical
practitioners have been investigated and convicted
of health care fraud including but not limited to:
DME suppliers, MD/DO of just about every specialty,
PT, psychologists, social workers, nurse
practitioners, PA to name a few. As a wise man once
told me, if you take money from the Federal Gov't
you best heed to their policies, because the same
hand that giveth will both take the money back and
send you away!

Paul Kesselman, DPM<, Oceanside, NY

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