A wrongful termination lawsuit has led to accusations improper billing practices in a business comprised of nine doctors and six clinics. After firing an employee for "ongoing inappropriate and abusive conduct toward her supervisor and fellow employees" a Texas office may now face a Medicare fraud investigation if the fired employee's story is given credence by investigators.
The employee, who has her coding certification to submit bills to the Medicare program for reimbursement, claims in the wrongful termination lawsuit that she was asked to perform illegal acts by billing for services that were not provided, billing for more expensive procedures than were performed, and for charging Medicare patients the difference between the Medicare reimbursement amount and the amount the doctors would charge a non-Medicare eligible person. These acts, if true, would amount to Medicare fraud and would expose the doctors and others involved to criminal prosecution.
It is illegal to fire someone for their refusal to commit illegal acts. By making these assertions, the fired employee is justifying the wrongful termination lawsuit and could stand to receive a significant payout. It is not clear if the former employee has yet provided any evidence of wrongdoing that would substantiate her story. But with federal prosecutors eager to prosecute anyone they suspect of health care fraud, it is a sure bet that the matter will receive further attention.
Source: Dallas Observer, "Lawsuit Accuses Dallas Doctors of "Drive-By Billing" and Other Systemic Medicare Fraud," by Eric Nicholson, 27 July 2012