Medicare Compliance & Reimbursement

Why one physician had to hand over half a million to Medicaid.

Physician practices that bill services provided by both nurse midwives and physicians must be sure to separate those claims correctly.

Example: A Florida doctor who took credit for deliveries he did not attend got slapped with a costly lawsuit, state Attorney General Charlie Crist said Oct. 12. 

Dr. Thomas Armbruster has agreed to pay more than $550,000 - triple Medicaid's actual damages - for alleged billing errors.

The doc's practice, West Pasco Obstetrics and Gynecology Center, apparently billed Medicaid using Armbruster's physician provider number for services - many of them expensive and high-risk - that nurse midwives provided. Armbruster also reportedly billed Medicaid for a higher level of care than the patients actually received.

"It is outrageous to think that a physician would not only bill for a service not rendered, but would also deliberately misrepresent the kind of service provided to bilk the system," Crist said.

Lesson Learned: Prosecutors continue to crack down on physicians who bill for services provided by mid-level providers.