The United States Centers for Medicare and Medicaid Services (CMS) recently announced expansion to its accelerated and advanced payment program. The agency states the changes are intended to help providers who receive payment from Medicare to get the funds they need while battling the 2019 Novel Coronavirus (COVID-19).
In addition to years of schooling and practical education, countless examinations and continued education courses throughout one's medical professional life, doctors must also keep their medical license active and in good standing in the state they practice. A failure to do so can end their career.
It is not uncommon for physicians to take a business interest in a health care facility. Such business relationships must be entered into carefully or the physician could face allegations of illegal kickbacks and other criminal violations. A recent case provides an example.
Data shows approximately half of all physicians will face a medical malpractice lawsuit at some point during their professional career. Top causes for a lawsuit include a failure to diagnose an illness or a poor outcome after a medical procedure.
Two physicians and an operating room technician filed a whistleblower lawsuit against a group of neurosurgeons and the medical facility where they operated. The whistleblowers accused the medical professionals of falsely inflating the number of spinal surgeries in an effort to increase their earnings and patient referrals. The hospital countered that the practices used were standard throughout the profession. If the whistleblower can support the claim, the allegations result in a violation of the Stark Law and the Anti-Kickback Statute (AKS).
Private practices in Texas must navigate federal, state and local health care regulations. They must stay current and make sure their businesses are in line with any changes to the law. As a result, private practices throughout the state are likely reviewing their billing practices to make sure they are in line with a newly passed law designed by lawmakers to limit surprise billing.
The Texas Legislature has recently proposed a new rule that will limit health billing options. Lawmakers state the new law, scheduled to go into effect January 1, will help protect patients from surprise medical bills. But medical professionals have voiced concern the law may have unintended, negative consequences for patients.
The case began when a 32-year-old woman began to investigate her family tree. She knew her parents had used a donor for conception, as they had struggled with fertility issues. When her own son began to suffer from severe health problems she began to investigate her family history to see if there was a genetic explanation.
Physicians and other medical professionals that face allegations of wrongdoing can find themselves dealing with more than just a government investigation. In many cases, these allegations can result in action by the state licensing board.
Seven Osteo Relief Institute (ORI) clinics from throughout the country have agreed to settle a Medicare fraud claim with the government. Two clinics are in Texas, one in Dallas the other San Antonio. The others are in Phoenix, Arizona, Lexington, Kentucky, Wall Township, New Jersey and Colorado Springs, Colorado. The United States Department of Justice (DOJ) states the clinics knowingly billed Medicare in violation of the False Claims Act.