Part B Insider (Multispecialty) Coding Alert

Published on Thu Jan 24, 2008 PDF

No entities were spared by the OIG in 2006

If you want to know who got caught in the OIG's net in 2006, we-ve got a breakdown for you.

The HHS Office of Inspector General-s (OIG-s) recently-released Health Care Fraud and Abuse Control Program report for 2006 offers examples of several OIG recoveries. The following breakdown can show you just what the government discovered so you can avoid facing the same fate:

Physician fraud:

One physician hired an unlicensed practitioner, referred to that practitioner as -doctor- and allowed the practitioner to treat patients and write prescriptions. The physician billed insurers for the practitioner's services, but claimed that the physician personally performed the services. Both practitioners pled guilty and were sentenced to two months of imprisonment and asked to repay $160,000.

One dermatologist was sentenced to 20 years in prison and asked to pay $880,000 in restitution for providing kickbacks that weren't always monetary--some kickbacks involved medically unnecessary prescriptions for addictive substances. The physician would offer the prescriptions to induce patients to return to the practice and would then bill insurers for the visit, even though the physician provided no services.

Nonphysician practioners:

One audiologist faced 78 months in prison and $868,000 in restitution for billing Medicare for hearing aids, speech therapy and other services, despite the fact that the audiologist had no physician referral for the services and no license to render them.

Device manufacturers:

Medtronic Inc. paid the government $40 million to settle allegations that it paid kickbacks (in the form of lavish trips, sham consulting agreements and other types) to physicians to induce them to use Medtronic's spinal products.

Podiatrists:

One podiatrist faced 78 months in prison and $528,000 in restitution for billing services under other podiatrists- names without their permission because the podiatrist had been excluded from Medicare for defaulting on student loans. In addition, the podiatrist billed Medicare for complex procedures when in fact only nail-trimming took place.

Chiropractors:

One chiropractor was sentenced to more than 12 years in prison and ordered to pay $1.5 million in restitution for handing out $100 back braces to senior citizens at group presentations and billing federal programs $1,300 per brace for the products.

To read the OIG report in its entirety, visit www.oig.hhs.gov/publications/docs/hcfac/hcfacreport2006.pdf.