On August 28, 2009, Dr. Clifford J. Wolf, DPM was sentenced in federal court in San Diego by the Honorable William Q. Hayes to serve five months in custody and five months home detention and pay a $5,000 fine based on Wolf’s conviction for one count of health care fraud in violation of 18 U.S.C. Section 1347. Dr. Wolf pled guilty on May 28, 2009. This is Case No. 08-CR-1542-WQH .
Dr. Wolf is a podiatrist with a primary office in Poway, California, who treated patients throughout San Diego County and was an approved Medicare provider. According to court documents, since at least 1999, Wolf engaged in a scheme to defraud Medicare by billing multiple times for surgical procedures called “incision and drainage” services that he did not perform for his patients, when instead he merely trimmed and filed the beneficiaries’ toenails. Dr. Wolf allegedly fabricated progress notes in the patients’ charts in an effort to have the records and diagnoses correspond to the services billed so that he could get paid.
As part of his guilty plea, Dr. Wolf pled guilty to count one of the fourteen-count indictment and admitted that he knowingly and willfully defrauded Medicare of approximately $66,347 from January 1, 2003 through December 31, 2006. Dr. Wolf paid that amount in restitution to the Medicare program prior to the sentencing.
On the same day as the sentencing, the United States filed a civil lawsuit today in U.S. District Court in San Diego against Dr. Wolf and his business, Wolf Podiatry Corporation, alleging violations of the False Claims Act. The False Claims Act provides that anyone who submits a false claim is liable for three times the monetary amount the government has been damaged and for penalties of $5,500 to $11,000 for each false claim submitted to the government. The government’s civil lawsuit against Wolf and Wolf Podiatry Corporation is Case Number 09cv1875JLS RBB.
Attorney Comments: This case is notable since the government is getting more aggressive about having a parallel civil case so they can recover treble penalties even where restitution has already been repaid. Further, the civil case was not filed until the doctor was sentenced.
Podiatric services have been heavily investigated by Medicare and Medi-Cal these past two years and we can expect to see more administrative overpayment cases in addition to the occasional criminal case. The fabrication of records here probably helped move this case to the criminal arena instead of leaving it as an administrative matter since the false records make criminal intent easier to prove.
We cannot stress enough the danger of altering records during audits or when records are requested by any company or government agency. Before you even think of altering or adding records -- seek the advice of experienced health care law counsel. There are ways to supplement your records and documenting the care rendered even if your patient records are inadequate to support the services billed. It may not be enough to obtain full payment or avoid overpayment - but fabricating records has negative consequences with the licensing boards and criminal exposure that make it unnecessarily risky.
Any questions or comments should be directed to: firstname.lastname@example.org. Tracy Green is a principal at Green and Associates in Los Angeles, California. They focus their practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing licensed health care providers including, but limited to, podiatrists. Their website is: http://www.greenassoc.com/