Helpful Tips to Avoid Healthcare Fraud Prosecutions

Monday, April 11, 2022
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Physicians who are approached by non-physicians seeking to entice them into business ventures that make money quickly, should be very leery.  If the business venture offers good financial compensation for little or no work, RUN! Most often those involved in criminal enterprises are just seeking a physician they can sucker into a situation where they can use his/her Medicare identification number and name to order unnecessary tests, prescriptions or medical equipment. 

In the recent past, such get rich quick schemes have included compounded medications, motorized scooters and wheelchairs, genetic testing for COVID or other medical conditions, leg braces and knee braces.  Often the physician whose number is abused receives very little compensation; on the other hand, the services and products ordered result in payments from Medicare, Tricare, and other payers for tens of thousands of dollars.




Facts That You Should Look for to Avoid Scams.

Here are some tips that you should look for so you can avoid a scam:

1.    You are offered money to "review" and "authorize" medical services, products or equipment, without ever seeing a patient in person.

2.    You are asked to review an audio recording of a patient encounter that someone else has performed and to authorize medical services, products, or equipment for that patient, but you, yourself, have never seen or spoken to that patient.

3.    You are asked to review patient records or reports and to authorize medical services, products, or equipment but you, yourself, have never seen or spoken to that patient.

4.    You have no idea how much the medical services, products, or equipment you authorize actually cost.

5.    The medical services, products, or equipment you are being asked to authorize for a patient would normally fall outside of your regular area of medical practice (e.g., a podiatrist being asked to authorize genetic testing, a radiologist being asked to authorize laboratory diagnostic testing,  a dentist being asked to authorize a compounded skin cream for pain).

6.    The medical services, products, or equipment that you are being asked to authorize for a patient are so expensive that a patient would ordinarily not be able to afford them if a self-pay patient.

7.    The medical services, products, or equipment that you are being asked to authorize for a patient are so expensive that you would not ordinarily order them for a self-paying patient.

8.    You have never heard of and have no idea of who or what the 1ab, company, pharmacy or DME supplier providing the service or product is, or its reputation in the medical community.

9.    The patients for whom you are asked to authorize the medical services, products, or equipment, are only covered by one payer (e.g., workers compensation, Medicare, or Tricare);  patients from other than that one payer are not being sent to you.

10.    You never actually see the patient.


Click here to read about a recent case in Florida involving a genetic testing scam.


Contact Health Law Attorneys Experienced in Medicare Fraud and Durable Medical Equipment Supplier Cases.

The attorneys of The Health Law Firm represent physicians and medical groups that are being audited or investigated by Medicare, Medicaid, Tricare, or insurance companies.  They also represent nurse practitioners, dentists, podiatrists, and healthcare professionals who order testing or medical equipment.  They represent durable medical equipment (DME) suppliers, pharmacists, pharmacies, testing facilities, labs, and other health care providers in Medicare audits, ZPIC audits, MAC audits and RAC audits throughout Florida and across the U.S. They also represent DME suppliers, physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions, termination from the Medicare or Medicaid Program and administrative hearings.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or Toll-Free (888) 331-6620.


About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 Toll-Free: (888) 331-6620.


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4/11/2022

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