Prosecutors have been aggressive in their pursuit of possible Medicaid and Medicare fraud. In this regard, a Miami-Dade County health care facility that provided services to individuals with infectious diseases has been under investigation. The Florida clinic, its two owners, an Iowa physician and a physician’s assistant have all been accused of Medicaid fraud.

The doctor had been employed by the medical facility during 1999-2001. During that time, the facility records indicate that the physician treated patients with HIV and Hepatitis-C. With respect to those patients he prescribed the applicable medication. 

The charges against the doctor are that the prescription drugs were actually never administered to the clinic’s patients. It is alleged that the clinic billed Medicaid for the prescriptions and that these resulted in false bills. The claim is that the total amount of improper billings was approximately $4.7 million.

In defense of the physician, once a medication is prescribed it is not typically the role of the doctor to administer the medication. Rather, this task is generally done by a nurse or physician’s assistant. In addition, the physician was not himself involved in billing Medicaid. Presumably someone other than a physician would handle this administrative matter.

The ultimate claim against him then is that he allowed the clinic to use his Medicaid provider number in Florida for the services provided. Presumably, he would be required to provide his Medicaid provider number to any clinic he is employed by and it could be argued that he should not be held responsible if the clinic were to use it improperly.

In February of 2010, the physician pleaded guilty and was placed on probation for four years. He was also forced to pay $100,000 in restitution. In all probability, this deal was made so that he could avoid jail time if the prosecutors were to successfully convict him at trial.

On December 31, 2010 the physician was forced to surrender his medical license in settlement with the state of Iowa and a disciplinary action that the Iowa Board of Medicine had filed against him in connection with the Florida investigation. Considering that there were many different people involved and that any one of them might be responsible, the outcome for this physician may have been harsh.

Source: The Iowa Independent, “Iowa physician involved in Florida Medicaid fraud surrenders license,” Lynda Waddington, 7 Jan 2011

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