Admin Emeritus & Elite Member
- Jan 26, 2000
I read rather quicklyHere is the break down of the fraud and the return in revenue.
It's 97 pages so you better loadup the printer before hitting "print"
This isn't a comprehensive list, but highlights which are naturally going to point to favorable cases.
I'm not saying that there isn't true fraud because that would be a lie, and it needs to be punished. I will call your attention to titbit.
Note that there is no medical impropriety here. No question of the qualification of those involved. The government created this regulation based on something other than medical necessity and unfortunately many institutions learned of this requirement hidden among the regs after an audit. Properly trained people were giving the needed treatment correctly and got snagged because of a nonsense regulation. Why? Because then can be. Reasonableness is not a requirement of regulation.In April 2011, Dartmouth Hitchcock Clinic, Mary Hitchcock Memorial Hospital, and related entities (collectively Dartmouth), agreed to pay $2.2 million to resolve its liability under the FCA for allegedly submitting improper claims to Medicare, Medicaid, TRICARE, and the Veterans Administration.
Between February 1, 2001 and September
30, 2007, Dartmouths Anesthesiology Department (AD) allegedly submitted improper claims for services not supervised by attending physicians in the ADs Pain Clinic,28 submitted improper claims for services not supervised by attending physicians related to bedside procedures, and submitted improper claims for time based billings in the ADs Critical Care Unit.
According to federal regulations and related guidelines, physicians are allowed to bill for certain services provided by residents, but only if those services are performed while a physician is present and the medical record documents physician presence.