Sunday, December 4, 2016

Nursing Home Physicians, Be Careful. Illinois Psychiatrist Pays $908,000 to Settle Civil Allegations of False Billing for Evaluation and Management Services. 10 Year OIG Exclusion Part of Settlement.

On November 8, 2016,  a Springfield psychiatrist, Duttala Obul Reddy, settled allegations of false billing for services provided to nursing home residents in central Illinois.  The false claims lawsuit filed by the government alleged that from January 2008 through February 2013, Dr. Reddy allegedly submitted bills for evaluation and management services provided at long-term care facilities that either had not been provided or had not been provided to the extent claimed. 

Under the terms of the settlement agreement, Dr. Reddy denies the allegations that he submitted or caused submission of false claims for payment under Medicare and Medicaid for medical services. The terms of the settlement required Dr. Reddy to pay $908,000 and to agreed to his exclusion from participation in Medicare, Medicaid and all other federal health care programs for a period of 10 years. The settlement had the U.S. District Judge Myerscough enter judgment in favor of the government and against Dr. Reddy.

Attorney Commentary: Physicians who work at nursing homes are held to the same standards as private practitioners in billing. This particular psychiatrist had issues with the state licensing board due to alleged boundary violations and that may have triggered these audits. While nursing home visits may result in billing on a regular schedule, it is critical for doctors to ensure that visits are only billed if they occurred and to be very careful to avoid upcoding. The type of OIG exclusion that occurred in this case can be detrimental to a career given the pervasiveness of government funding of health care in hospitals, nursing homes and insurance.

Posted by Tracy Green, Esq.
Green and Associates, Attorneys at Law
Phone: 213-233-2260


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