Wednesday, October 28, 2015

California Podiatrist Pleads Guilty To Federal Health Care Fraud For Upcoding, Providing Services Not Medically Necessary, Using Unlicensed Staff, Improper Billing, and Altering Records

For over ten (10) years, podiatry has been a red flag for Medicare auditors. The rules for podiatry services are strict and a podiatrist recently agreed to plead guilty to Medicare fraud based solely on podiatry services.  

On October 23, 2015, a podiatrist, Neil A. Van Dyck DPM, who operated a podiatry practice in Roseville, California called Placer Podiatry pleaded guilty to health care fraud in the Eastern District of Caifornia. This was under a plea agreement and was negotiated between the government and Dr. Van Dyck’s attorney.

According to court documents, Dr. Van Dyck was a California-licensed podiatrist. Van Dyck offered “spa”-like treatments and performed routine foot care at his practice.

Between 2009 and 2014, however, the government alleges that Dr. Van Dyck submitted over $2.8 million in fraudulent claims for reimbursement to Medicare, Medi-Cal, Tricare and private insurers (where about $1 million was paid) by doing the following:

1.  Dr. Van Dyck allegedly falsely claimed that he performed more expensive procedures than he actually performed and that some of these procedures were “spa-like” rather than medical procedures;

2.  Dr. Van Dyck allegedly falsely claimed that the routine foot care that was provided was justified  because of illness or symptoms that were not present; 

3.  The treatments were allegedly performed by unlicensed staff sometimes when Dr. Van Dyck was not present at his practice; 

4.   Dr. Van Dyck allegedly altered a single-use skincare patch by cutting it into pieces and billed Medicare for multiple applications; and

5.  In response to a request for documents from an investigator for Medicare, Dr. Van Dyck allegedly altered patients’ medical records to justify his fraudulent bills.

Dr. Van Dyck is scheduled to be sentenced by Judge Garland E. Burrell Jr. on January 15, 2016. The plea agreement is sealed and thus the sentence that he faces is not know.  Dr. Van Dyck faces a maximum statutory penalty of 10 years in prison and a fine of $250,000 or twice the loss or gain but with a plea agreement it would be highly unlikely that the maximum sentence would be imposed. The actual sentence, however, will be determined at the discretion of the court after consideration of any applicable statutory factors and the Federal Sentencing Guidelines, which take into account a number of variables.

Attorney Commentary: As I have seen in many cases over the years, the alteration of patient records in request to an audit or subpoena for records is being used to show fraudulent intent. While physicians may see issues in records and seek to correct them, they do not understand that changing records (unless those changes are noted in the charts on the date performed) can be used against the physician.

Moreover, physicians who bill services need a compliance plan and method for evaluating billing and procedures. Billing mistakes will happen but when it goes on for over 5 years, the billings add up. In fraud cases, it is the amount “billed” that is used for sentencing on loss amounts and not the amount “collected.” While the amount collected is relevant for sentencing, it is better for providers to catch mistakes themselves. Physicians will bill and be paid for years and assume that they must be doing it right.

Medicare is a “good faith” billing system. Medicare and Tricare pay and reserve the right to audit and challenge all billing for the prior 6 years. Do not assume that simply because you are being paid that the billing and documentation is correct. Get a compliance plan to keep your billing out of the claims that there is any “fraud,” “lack of medical necessity,” or “lack of documentation.”

Posted by Tracy Green, Esq.
Green and Associates
Office: 213-233-2260


DISCLAIMER: Green & Associates' articles and blog postings are prepared as a service to the public and are not intended to grant rights or impose obligations. Nothing in this website should be construed as legal advice. Green & Associates' articles and blog postings may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents and contact their attorney for legal advice. The primary purpose of this website is not the commercial advertisement or promotion of a commercial product or service and this website is not an advertisement or solicitation. Anyone viewing this web site in a state where the web site fails to comply with all laws and ethical rules of that state, should disregard this web site.

The information provided on this website is for informational purposes only. It is not intended to create, and does not create, a lawyer-client relationship with Green & Associates, Attorneys at Law. Sending an e-mail to Tracy Green does not contractually obligate them to represent you as your lawyer, or create any type of client relationship. No attorney-client relationship will be formed absent a written engagement or retainer letter agreement signed by both Green & Associates and client and which specifies the scope of the engagement.

Please note that e-mail transmission is not secure unless it is encrypted. E-mail messages sent to Ms. Green should not include confidential or sensitive information.