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Whistleblower targets Houston neurologist for healthcare fraud

Officials recently pursued allegations of healthcare fraud against a neurologist from Houston, stating his neurology group falsely billed Medicare Part B for services that were either not medically necessary or provided by untrained and unlicensed technicians. In addition to these allegations of false claims, the authorities also accused the physician of violation of the Stark Law. These allegations were tied to billing practices for imaging procedures as diagnostic centers allegedly owned by the physician and span from 2014 through 2021. When faced with the allegations, the neurologist chose to settle the claim.

This case provides two important lessons.

#1: The authorities are aggressive in pursuit of Stark Law and false claim cases.

This case began when a whistleblower filed a complaint under the False Claims Act. The whistleblower stands to gain 18% of the proceeds from the settlement. The law allows individuals to file these types of lawsuits and the government may then choose to join the lawsuit. If the case seems plausible, the government will aggressively pursue the claim — as was the case in this example.

#2: The problem often starts within the practice.

This case also highlights the importance of conducting regular internal audits to make sure all practices follow applicable regulations. Entities and individuals in healthcare must carefully navigate these regulations to avoid the harsh consequences of violations. Compliance programs and ongoing education are key strategies to mitigate risks associated with the Stark Law and the AKS. In this way, the healthcare community can focus on its primary mission: to deliver quality care without the shadow of fraud and abuse.

Attorney John Rivas is responsible for this communication.