Rachel V. Rose, JD, MBA, advises clients on compliance and transactions in healthcare, cybersecurity, corporate and securities law, while representing plaintiffs in False Claims Act and Dodd-Frank whistleblower cases. She also teaches bioethics at Baylor College of Medicine in Houston. Rachel can be reached through her website, www.rvrose.com.
Recent legal cases show why physicians need to remain buttoned-up tight when it comes to the legal side of practicing medicine.
Several recent fines and jail sentences underscore the importance of physicians being above board in claim submissions and prescribing habits.
Every physician knows that certain actions lead to civil and criminal liability. Among the top actions are inappropriate prescribing (especially of medically unnecessary controlled substances); violating Stark and Anti-kickback Laws; not being HIPAA/HITECH Act compliant, and submitting fraudulent claims for reimbursement. Needless to say, the recent actions fall within these same categories. Here are some of the highlights, which should serve as a gut check for physicians.
•In Detroit, Dr. Abdul Haq, plead guilty to conspiring to commit healthcare fraud. Specifically, he conspired with the owner of Tri-county Network and others to "prescribe medically unnecessary controlled substances, including Oxycodone, Hydrocodone, and Opana to Medicare beneficiaries." Furthermore, medically unnecessary procedures, such as injections into the facet joint, were performed and submitted for payment.
•In Los Angeles, the owner and operator of Angeleno Clinic was sentenced to 37 months in prison for prescribing and billing Medicare for medically unnecessary services and equipment.
•In Mississippi, Dr. Harold Peltan was arrested after being indicted by a grand jury on 17 counts of Medicare fraud.
Other actions that resulted in health care providers (e.g., hospitals) on the hot seat include violations of the Controlled Substances Act and Medicare fraud for medically unnecessary treatments, which were submitted to the government for payment.
For example, Appalachian Regional Healthcare, Inc. paid a fine to settle a law suit that was filed in 2016 by the United States Department of Justice that it "knowingly filled fraudulent prescriptions for Schedule IV stimulants" and failed to keep adequate records.
As for HIPAA and the HITECH Act violations, 2017 started with a surge of fines that ranged from cases including overlooking risks to not having a business associate agreement to violating the privacy rule. According to the HHS website, there has not been an announcement since May 23, 2017. One never knows what is brewing behind the scenes or when the next flurry of activity will surface. Hence, it is always prudent to make sure that one's practice is complaint with HIPAA and the HITECH Act.
In summary, physicians should be honest and complaint. Doing so may enable a physician to avoid civil and/or criminal penalties.