Low-cost Medicare Fraud Exposes Doctor to Prison and Hefty Fines
The Denver Post published an article about an Ohio podiatrist, Anthony Innocenzi, MD, who practiced medicine in Grand Junction, Colorado, and who pleaded guilty to Medicare fraud. The case is important, and should make providers pause and think, because it demonstrates that even a small amount of inappropriately obtained money can serve as the basis for a fraud investigation and prosecution by the government.
Innocenzi practiced podiatric medicine at a nursing home, but claimed he saw patients in an office. Use of the office place of service code qualified him for higher reimbursement levels than he should have received. Although the scheme only cost Medicare $2,000, “the doctor could be sentenced to 10 years in a federal prison and to a three-year supervised release term and be fined up to $250,000,” Senior U.S. District Judge John Kane said. A probationary term is also possible.
Because Innocenzi’s guilty plea is a felony count of insurance fraud, he is now on Medicare’s Exclusion List.
AAPC’s National Advisory Board, Legal Advisory Board, and Ethics Committee member, Michael Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, alerted AAPC and noted that this case is significant to healthcare providers because “it demonstrates that even small overpayments can cause criminal trouble for physicians.”