Feds recently accused a physician of falsely certifying patients for home health services. The prosecution is aggressively building a case against the medical professional and claims that she received financial incentive for these certifications.
What exactly happened?
According to the government, the physician would provide the paperwork needed for home health service providers to bill Medicare and Medicaid for treating patients. The government claims that these services were not medically necessary. As a result, they state that the physician is guilty of healthcare fraud.
How does a home health certification lead to allegations of healthcare fraud?
For two reasons: first, the certification allowed for the provider to bill Medicare. Whenever a government agency, like Medicare, is involved there is potential for fraud charges. Second, the physician also allegedly received financial gain in the form of cash benefits from the home health care facilities for providing the certifications.
Allegations like these will likely lead to an investigation. If evidence is found to support the claim, the government may attempt to move forward with claims the accused violated the federal Anti-Kickback Statute (AKS) or the Stark Law, a civil statute, as was the case in this instance.
How serious are these allegations?
Very serious. The feds state that Medicare and Medicaid paid over $6 million in claims to home health services agencies related to these false certifications. The physician is wise to build a defense to the allegations. If convicted, the accused faces up to ten years imprisonment for each charge. At this time, the physician currently faces four counts of healthcare fraud.