Healthcare News & Insights

Inappropriate billing costs doc & hospital $1M to settle

Are ALL of your physicians billing properly for their services? If they aren’t, your hospital will be held responsible, too. That’s what happened at Temple.

The False Claims Act makes it illegal for any person or entity to present a false or fraudulent claim to the United States government for payment and/or to retain overpayments that were improperly received.

Furthermore, Medicare and Medicaid only reimburse hospitals for services that attending physicians performed or for which attending physicians were present for the critical portions. By signing off on claims, physicians certify that they were physically present when the critical portion of the services were performed.

Therefore, when Dr. Joseph Kubacki, formerly the chairperson of the Ophthalmology Department at Temple University School of Medicine, and a former attending physician at Temple University Hospital, billed for more than $1.5 million in services performed by residents when he wasn’t physically present in the hospital, he was committing fraud.

And on August 22, 2011, he was convicted of healthcare fraud, along with other charges.

In addition, by submitting the claims and accepting payment, Temple was also committing fraud.

Voluntary disclosure

Temple discovered the billing misconduct through an internal audit, and voluntarily brought it to the government’s attention.

Due to Temple’s self-disclosure, cooperation with the government’s investigation, improvements in its compliance program and the termination of the physicians involved, the feds decided to reach an amicable resolution.

End result: Temple agreed to pay $412,474 and Dr. Kubacki agreed to pay $676,100.

Additional problems

But Dr. Kubacki wasn’t alone in his “inappropriate billing.” This settlement also pertained to false billing practices of the same kind in Temple’s plastic surgery department.

While Temple trained its physicians in charting and billing requirements, it didn’t prevent some of them from committing fraud.

That’s why it is so important to make sure your hospital does regular internal audits throughout the facility. And that your physicians are required to stay current on charting and billing requirements.

Tens of billions of dollars are lost every year to Medicare and Medicaid fraud, and the government isn’t about to let that money go. It’s committed to putting an end to it, and will punish those who take advantage of the healthcare system.



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