As with our previous week’s report, enforcement cases involving the healthcare industry announced last week were light in lab-related issues. However, improperly billing doctors was a key theme.
The First Case
In the first case, announced by the U.S. Department of Justice (DOJ) on Nov. 10, a pediatrician pleaded guilty in federal court for his role in “a larger nationwide scheme to defraud Medicare.” Waiving his right to a grand jury, the doctor, Frederick Scott Dattel, 57, owner and operator of Kansas City Pediatrics, L.L.C., pleaded guilty “to a federal information that charges him with making a false statement related to a health care matter,” the DOJ said in a press release.
Dattel played a role in causing claims for more than 1,000 beneficiaries to be submitted to Medicare for medically unnecessary equipment and medication while he was working for a telemedicine company called RediDoc, L.L.C. RediDoc’s owners paid Dattel and other doctors bribes and kickbacks in exchange for high volumes of expensive prescriptions and durable medical equipment orders that were not medically necessary. RediDoc’s owners have already pleaded guilty to conspiracy to commit healthcare fraud.
According to the DOJ, Dattel’s orders led to at least $312,392 to be billed to Medicare, of which $211,542 was paid. He received a total of $22,270 from RediDoc for these orders. As part of his guilty plea, Dattel must pay the $211,542 in restitution. He could also face up to five years in prison without parole.1
The Second Case
In another case involving kickbacks and False Claims Act allegations, a physician and a medical office that he was owner and principal member of agreed to settle the claims for just over $2.6 million on Nov. 10. According to the DOJ, Kevin P. Greene and Feel Well Health Center (now doing business as Confidia Health Institute), allegedly improperly billed state and federal healthcare programs and were paid kickbacks for submitting those claims.
Specifically, Greene and Feel Well billed the State of Connecticut Comptroller Healthcare Programs, Connecticut Medicaid, and Medicare for medical visits that were actually “fitness-related services” provided at a gym they operated, and that those services had “no legitimate medical component.” Feel Well and Greene allegedly attempted to cover up the false claims by creating phony medical records for the visits and attaching “false diagnoses” to these records.
In addition, Greene and Feel Well are alleged to have:
- Billed for in-person medical services when Greene was not physically present
- Billed for telemedicine services that “did not meet applicable telemedicine requirements for office location or use an interactive telecommunications system”
- Billed for “medically unnecessary testing or procedures for neurofeedback, ultrasounds, and autonomic function testing”
- Received kickbacks from Boston Heart Diagnostics Corp. in exchange for ordering “clinical laboratory services for Medicare patients”
In addition to the settlement, which Feel Well and Greene will pay interest on, the two have also entered into a three-year billing Integrity Agreement with the U.S. Department of Health and Human Services.2
The Third Case
In a third case announced Nov. 14, a Pennsylvania psychiatrist was charged with four counts of healthcare fraud for billing Medicare for services he never actually provided. According to the DOJ, Muhamad Aly Rifai, 49, sole owner of Blue Mountain Psychiatry, received a minimum of roughly $1.36 million as a result of these false claims. He could face a maximum fine of $1 million and up to 40 years in prison if he is convicted.3
Another Key Case from the Week
Nov. 14: A Florida healthcare plan settled False Claims Act allegations for $51 million, resolving a qui tam whistleblower lawsuit. The Florida Birth-Related Neurological Injury Compensation Plan and its administrator, the Florida Birth-Related Neurological Injury Compensation Association (NICA) were accused of causing its members “to submit their healthcare claims to Medicaid rather than NICA, in violation of Medicaid’s status as the payer of last resort under federal law,” the DOJ said in a statement.4
References:
- https://www.justice.gov/usao-wdmo/pr/kc-pediatrician-pleads-guilty-300000-medicare-fraud
- https://www.justice.gov/usao-ct/pr/physician-and-medical-office-pay-over-26-million-settle-false-claims-act-and-kickback
- https://www.justice.gov/usao-edpa/pr/lehigh-valley-psychiatrist-charged-stealing-medicare-through-improper-billing-scheme
- https://www.justice.gov/opa/pr/florida-birth-related-neurological-injury-compensation-plan-and-association-pay-51-million