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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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