The medical profession's first concern should be the welfare of the patient. Most physicians, nurses and other medical professionals go into this field because they share a similar belief. However, as is true in any profession, there are some who stray and find the lure of financial rewards too much to ignore.
Health insurance companies may request a copy of billing records to substantiate claims for payment. If not provided in a timely manner, the company could report physicians who fail to comply to the state medical licensing board. Unfortunately, additional problems can arise if the requested records are provided but put together poorly.
The Texas Medical Board is scheduled to again meet here in Austin at the end of next month. The board will again discuss its budget and policies and then consider complaints filed against doctors, as it did in its most recent session.
Medical errors are responsible for hundreds of thousands of deaths in the United States every year. A portion of these mistakes happen within the operating room. This statistic inspired a master’s student from Columbia University’s Data Science Institute to search for a resolution.
The Department of Justice continued its crack down on healthcare fraud in 2018. This year included the $1 billion “Takedown Day.” On this day, police officers arrested and charged over 600 individuals for involvement in a $2 billion healthcare scheme. This is just one example of the government’s efforts to thwart healthcare fraud. Additional examples from throughout the year include:
It would seem advantageous for medical professionals to discuss concerns about the quality of care provided to patients. One would hope hospital executives would appreciate updates from physicians about concerns.
The government has come down hard on yet another physician accused of playing a role in the nation’s opioid crisis. Seven individuals died from overdose, allegedly from medications prescribed by the accused physician. The government states the distribution of these controlled substances was outside the usual course of professional practice. The prosecution further argued that there was not a legitimate medical purpose for the prescriptions.
The federal government recently completed an investigation of a podiatrist and charged him with over 30 counts of healthcare fraud and identify theft. Generally, such allegations can lead to a five-year prison sentence. In this instance, the government is not recommending jail time. Instead, the government has recommended a sentence that includes probation and a fine.
The United States government recently accused a wife of criminal activity based on her husband’s alleged crimes. The government states the woman had knowledge of and knowingly participated in his alleged crimes. If convicted, she could face hefty fines and up to ten years imprisonment.
The Texas Medical Board (the Board) recently released a publication designed to offer guidance on required reporting obligations from hospital staff and other medical professionals. The piece specifically focused on required reporting efforts by individual physicians as well as medical peer review committees.