“Today’s sentence is not just a punishment — it’s a warning.” Matthew R. Galeotti, Head of the Justice Department’s Criminal Division made this statement in regard to a recent healthcare fraud case. The statement was directed to physicians throughout the country, and Mr. Galeotti plans to aggressively pursue any physician that he believes is using the profession for personal enrichment at the expense of patients.
It is a sentiment most physicians likely stand behind. Medical professionals enter the field to help patients. Most are doing just that. Unfortunately, something as simple as a billing error can snowball into allegations of criminal activity and that same physician can find themselves facing multiple charges of healthcare fraud. It is important that physicians recognize they are practicing medicine in a climate that is waiting for a mistake and will doggedly pursue allegations of wrongdoing.
The case that led to the statement noted above, involved a rheumatologist. The government successfully argued that Dr. Jorge Zamora-Quezada fraudulently falsified patient records and diagnosed patients with chronic illnesses they did not have. This led to decades of treatment and false billing. Upon review of the evidence, the court sentenced the physician to 10 years imprisonment and forfeiture of more than $28 million in assets.
Take away lesson: Review billing practices for compliance
Yes, providing high quality care is your primary focus as a physician. However, it is also important to make sure all practices within your group are in compliance with applicable regulations. This includes the more mundane administrative tasks like billing. In addition to regular internal audits to review billing practices, additional tips that mitigate the risk of allegations of a violation include:
- Be able to back up diagnoses: Medical professionals should conduct thorough examinations and utilize appropriate diagnostic tools to help better ensure accurate diagnoses. Avoiding unnecessary tests and treatments is essential to prevent harm and maintain ethical standards.
- Maintain transparent records: Keep accurate and transparent patient records. Falsifying records not only jeopardizes patient care but also exposes healthcare providers to legal risks.
The case of Dr. Jorge Zamora-Quezada serves as a cautionary tale for medical professionals, underscoring the importance of ethical practices, the severe consequences of healthcare fraud, and the importance of a proactive approach to avoid similar errors.
Attorney John Rivas is responsible for this communication.