PracticeLink Magazine

SUM 2018

The career development quarterly for physicians of all specialties, PracticeLink Magazine provides readers with feature articles, compensation stats, helpful job search tips—as well as recruitment ads from organizations across the U.S.

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32 S UMMER 2018 PracticeLink.com ▼ T HE I N T E rv IE W ISSUE D E P A R T M E N T S Reform Recap J e FF A t KI n SO n Fraud and abuse issues facing physicians The federal government is stepping up investigations of fraud and abuse. Physicians can take steps to reduce the risks. A te XAS I ntern IS t w I t H A HOM e H e AL t H CA re P r AC t IC e along with two others billed Medicare for more than $40 million in services, including for services that were not rendered or were not necessary. A Detroit physician billed Medicare for unnecessary opioids and pain-killing back injections. The prosecutor said that over a three-year period, the doctor prescribed for a single patient 2,640 Norco, 100 Percocet, 2,138 Soma, 1,220 Valium pills, and 4,200 doses of Promethazine with codeine. A New York City doctor took more than $25,000 in payments in exchange for referring patients to a particular laboratory. Five physicians in a California cardiology practice were accused of performing nuclear stress tests without first determining whether the test were medically necessary (or at least not having a consultation appointment within 30 days of the tests). For the first three cases, prison sentences were (or are likely to be) imposed. For the fourth case, the cardiologists agreed to settle the case for $1.2 million. The cases are part of an increased focus by law enforcement on fraud and abuse in health care. Coordinated enforcement The federal government takes the lead on many investigations, but it has ample help from state investigators and from insurance companies that alert the government to suspicious billing. A formal structure has been established to facilitate the coordination: the Healthcare Fraud Prevention Partnership, which includes most major insurance companies as well as the FBI, the Department of Justice and the u .S. Department of Health and Human Services. Federal laws used to fight fraud and abuse are criminal and civil. Criminal laws include the False Claims Act, health care fraud, mail fraud and wire fraud. In addition, civil laws are used to impose monetary penalties and to exclude providers from participation in Medicare, Medicaid and other federal health care programs. Since 2007, the Medicare Fraud Strike Force has charged more than 3,000 individuals with fraud. In fiscal year 2016, the federal government collected $3.3 billion as a result of health care fraud judgments, settlements and administrative dispositions. The government says the fraud control program returned $5 for each dollar invested.

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