Feds scour travel records to prove billing fraud
Feds scour travel records to prove billing fraud
Federal prosecutors in South Carolina allege that the Charleston-based Medical University of South Carolina (MUSC) and its affiliated physician practice, University Medical Associates (UMA) violated the False Claims Act by submitting bills to Medicare for physicians who weren’t present when the billed-for service was provided.
Experts say the case highlights the importance of scrutinizing Medicare claims to make sure bills aren’t simply submitted in the attending physician’s name, regardless of who performed the service.
Stuart Andrews, JD, an attorney with Nelson, Mullins in Columbia, SC, who represents the medical center and the physicians group in the case, acknowledges that until the mid-1990s, UMA routinely billed under the attending physician’s name, even if the attending physician wasn’t available and another physician provided the service in question. "The patients received the services, and the government got what it paid for," he says.
A source close to the case says UMA’s admission of its previous billing practices isn’t by itself damning: "During the last decade, there’s been a wider and more specific understanding of what the Health Care Financing Administration [HCFA] has expected in terms of documentation. As it became clearer that HCFA had an expectation that every bill should be submitted under the name of the physician who provided the service, then the providers conformed to that."
The problem in this case, according to prosecutors, is that at least in some instances, the physicians at UMA whose names appeared on Medicare claims weren’t anywhere near the hospital when the services were performed. For example:
- Prosecutors allege that in 1992, UMA billed for care supposedly provided by Peter Gazes, MD, even though he was spending two weeks in Greece at the time.
- Another physician was allegedly in Saudi Arabia when UMA submitted bills in his name, according to prosecutors. The U.S. attorney’s complaint says that residents and interns performed the actual work.
Earlier this month, MUSC and UMA won a small victory in the case, when U.S. District Court Judge Weston Houck ruled that the U.S. Attorney’s office could not broaden the scope of its investigation by examining the personal records of 54 more physicians affiliated with UMA.
Currently, prosecutors have investigated the records of 47 UMA physicians, including their credit card records, personal calendars, hotel and car rental receipts, and travel agency records, to determine whether the physicians were actually present at MUSC when bills were submitted in their name.
Even though charges haven’t yet been brought against the individual physicians, that doesn’t mean they’re off the hook, Andrews says. "The government will be seeking damages against the practice, rather than against the individual members or owners of the practice." And while no one’s talking money yet, UMA and its member physicians could stand to take a crippling financial blow if the government proves its case.
The qui tam suit was originally brought by several MUSC employees, including the former business manager of the department of ophthalmology, and a former director of internal audits and financial reporting at MUSC. The government joined only one of the claims the qui tam relators filed, the one regarding absentee billing, Andrews says.
Attorneys in the case will spend at least the next two months gathering depositions. The case is scheduled to go to trial in March 2000.
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