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Who gets to decide if medical treatment is adequate or excessive?

Physicians and other healthcare professionals enter the medical field to help provide care to patients. Each individual professional will vary slightly in how they provide care. This is normal. What can be frustrating is the question of who gets to decide if a physician’s chosen course of treatment went too far. When are treatment differences indicative of a professional opinion versus wrongdoing?

When the practice charges Medicare, Medicaid, and other government providers for these services, the government will likely have a say in these discussions. In a recent example, the government stepped in to review an ophthalmologist’s practice. The government claims the ophthalmologist crossed this line. They state the specialist and his team falsely diagnosed patients and provided excessive medical procedures to maximize profits.

What are the allegations in these types of cases?

In this example, the government has charged the ophthalmologist with one count of healthcare fraud and four counts of money laundering. He faces up to $250,000 in fines as well as 10 years imprisonment for the healthcare fraud charge and 20 years for money laundering.

How can my professional practice avoid similar allegations?

Physicians can reduce the risk of similar allegations by ensuring their efforts align with other practitioners. If not, it is helpful to have a good reason for the departure from similar specialists. It is also wise to keep medical records so you can support your chosen treatment in the event of an investigation.

Unfortunately, even when everything is done right, the government may feel that you went too far. Whether an honest mistake or a case of government overstep, it is important for healthcare professionals to take these allegations seriously. They can quickly escalate and result in accusations of criminal wrongdoing as highlighted in the case discussed above. As such, it is wise to seek legal counsel to review the case and help build a defense.

Attorney John Rivas is responsible for this communication.