Saturday, March 7, 2009

Medicare Fraud: Los Angeles Attorney Comments On Physician Las Vegas False Claims Case

On February 19, 2009, a federal jury today found Las Vegas anesthesiologist Eugene Chen, M.D. liable of committing federal health care fraud for submitting over 3,500 false or fraudulent claims to the United States Government between 1999 and 2006 for consultation services not requested or provided. This was a federal civil False Claims Act case.

The allegations against Dr. Chen pertained to Part B of the Medicare program, which is a voluntary subscription program of supplementary insurance covering items and services other than hospitalization, such as charges for medical care in physicians’ offices. Medicare Part B covers only services and procedures which have been determined to be medically reasonable and necessary. Physicians are permitted to present claims under Medicare Part B for consultations which are deemed appropriate and based on the level of complexity and amount of time spent with the patient. Physicians were permitted to bill for services in an amount set by a physician fee schedule.

The jury found that Chen submitted claims for consultation services that he had not been requested to perform and/or had not performed. In reliance on Dr. Chen’s false certifications on the claim forms, Medicare paid reimbursements to Dr. Chen totaling approximately $421,000. This amount will automatically be tripled under the False Claims Act, to approximately $1.26 million. Medicare would not have paid such claims had Dr. Chen provided truthful information.

On April 14, 2009, a hearing will be held to determine the amount of civil penalties to be awarded to the United States under the False Claims Act. The Government is requesting between approximately $1 million and $2 million in penalties.

Commentary: These are times when billing compliance is more necessary than ever. The government is getting more vigilant since the federal and state budgets are in crisis and they are seeking recovery of funds to help fund these programs. Without analyzing the facts it is difficult to know what the issues were and why Dr. Chen decided to proceed to trial.

The federal government is presently aggressive in pursuing physicians who who present false claims to the Government but where there is not enough evidence to pursue criminal charges. Anyone found violating the False Claims Act faces triple the proven damages, as well as civil penalties and costs of prosecution. 

Any questions or comments should be directed to:  Tracy Green is a principal at Green and Associates The firm focus its practice on the representation of licensed professionals and businesses in civil, administrative and criminal proceedings, with a specialty in health care providers


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