As 2017 comes to an end, here are recent settlements and cases that should urge physicians to evaluate their practices as we head into 2018.
Throughout the year, I write on a variety of topics for Physicians Practice. In 2017, topics included: sexual misconduct by physicians, the opioid epidemic and the role of providers, False Claims Act litigation and HIPAA/HITECH Act compliance strategies. As 2018 approaches, I wanted to provide some highlights of recent actions taken against physicians – either by the government or by individuals. Hopefully, people will learn from the mistakes of others and make appropriate changes, when necessary, to their own conduct.
1. Gymnastics Doctor Pleads Guilty to Sexual Assault Claims: Former United States Gymnastics Association physician, Larry Nassar, pled guilty in a Michigan court to felony criminal sexual assault stemming from allegations of over 100 young, female gymnasts. It goes without saying that physicians should avoid this type of behavior and to protect themselves and their patients, a nurse or assistant should be present at all times during examinations and procedures.
2. Attorney Generals Support Pennsylvania’s Suit over Contraceptive Mandate Exceptions: Multiple state attorneys general have come together to thwart the dialing back of the Affordable Care Act’s contraception mandate to allow employers to claim religious or moral exemptions. Importantly, oral contraceptives are widely utilized for medical conditions such as endometriosis, poly-cystic ovarian syndrome and amenorrhea. In doing so, a woman’s fertility is preserved. For physicians, the repeal could limit certain patient population’s access to care and necessary medication. In order to ensure patient compliance, this issue should be reviewed with the patient.
3. Philadelphia Doctor and Assistant Accused of Running an Opioid Pill Mill: Opioids have been on the forefront of the U.S. Government’s enforcement agenda since the beginning of the year. This summer, we saw a nationwide round-up of providers, as well as multiple suits against opioid manufacturers and distributors. This case in a Pennsylvania federal court emphasizes the notion of continued government enforcement.
4. Medicare Billing Fraud Leads Federal Prosecutors to Seek a 30 Year Sentence for a Florida Ophthalmologist: Medicare fraud has formed the basis of government actions and False Claims Act cases for years. This action against Salomon Melgen is no exception. Dr. Melgen was found guilty of overbilling Medicare by over $32 million and the government sought a lengthy sentence. This type of fraud is egregious because it takes money away from the Medicare Trust Fund and Medicare beneficiaries. It also contributes to rising healthcare costs. The take-away for physicians should be obvious – be honest and make sure that your billers and coders are intimately familiar with the appropriate way to code. Getting caught can be costly from a financial, legal and reputational standpoint.
As the business of medicine continues to evolve, physicians should attempt to stay at the forefront of major changes such as The Medicare Access and CHIP Reauthorization Act (MACRA) and cybersecurity. Making sure that codes are correctly allocated can stave off a significant lawsuit. In closing, some of the areas that I highlighted have simple solutions: treat patients respectfully and be honest.
Wishing all readers a Joyous and Prosperous 2018!