Part B Insider (Multispecialty) Coding Alert

Published on Fri Aug 14, 2009 PDF

• The Department of Justice has laid down the law on another infusion clinic employee.

On Sept. 2, the DOJ announced that a Detroit clinic manager pleaded guilty to defrauding Medicare and now faces a maximum of 10 years in prison and a $250,000 fine.

The clinic manager admitted that the clinic "routinely billed the Medicare program for services that were medically unnecessary or were never provided," the DOJ press release stated. She also "admitted that patients were prescribed medications at the clinic based not on medical need, but on what medications were likely to generate Medicare reimbursements."

The clinic submitted over $6.5 million in false and fraudulent claims over a six month period, resulting in almost $5 million in payments from Medicare.

The indictment was led by the Medicare Fraud Strike Force and the U.S. Attorney's Office for the Eastern District of Michigan.