Florida Doctor Jailed 5 Months for Lying to a Medicare Auditor

Lying to a Medicare auditor or otherwise obstructing a Medicare audit is a crime that can get you jailed. A 73-year-old endocrinologist specializing in diabetes management just learned that lesson the hard way.

The Medicare program integrity contractor was auditing his practice after his wife, who worked for an outside home health agency, became the subject of a Medicare fraud investigation. During the audit, the physician told the auditor that a third-party employer was renting office space. In fact, his wife would later admit after pleading guilty to health care fraud that she was actually using the space to improperly access patient data that was then used to generate referrals from the practice to the HHA without regard to medical necessity.

In addition to $118,831 in restitution, the doctor was sentenced to five months in jail followed by three years of supervised release.

Medicare/Medicaid Integrity Contract
Auditor Alphabet Soup

CMS uses different contract auditors to investigate participating providers, whether at random, in response to a particular suspicion, and/or as part of a targeted audit initiative:

CERT: Comprehensive Error Rate Testing Contractor
MAC: Medicare Administrative Contractor
RAC: Recovery Audit Contractor
UPIC: Unified Program Integrity Contractor