A Houston anesthesiologist was sentenced in federal court last week in connection with the use of her Medicare provider number. The woman's provider number was used to bill more than $29 million in fraudulent Medicare claims. The woman worked for City Nursing Services for a two year period where it was her role to decide which Medicare patients required physical therapy services. The owner of clinic used her provider number during her employment and continued to use it after she left. Last week, he was found guilty of Medicare fraud and received a sentence of 27 years in prison.
Shortly after beginning her employment at the clinic, the anesthesiologist discovered the improper use of her provider number and threatened to report the fraudulent billing. She also instructed him to report the billing mistakes to Medicare. At that point, the owner of the clinic began making large payments to her while continuing his fraudulent billing practices. The anesthesiologist did not follow through on her threat to report the clinic owner. That decision led the U.S. District Judge to sentence her to a minimum of 11 years in prison and ordered her to pay $15 million to the Medicare program.
Evidence of improper conduct by the clinic was ignored prior to the hiring of the anesthesiologist. A Medicare fraud professional had noted questionable billing at the clinic in 2006, but no action was taken. The Centers for Medicare and Medicaid Services were also aware of fraudulent billing practices, but took no action.
Medical providers should take note. If a provider number is used improperly, the owner of that number could be found guilty and imprisoned for not taking steps to stop the fraud. In this case, despite never fraudulently billing anyone herself, this doctor received a lengthy prison sentence for joining the Medicare investigator and insurance company in taking no action after discovering Medicare fraud.
Source: Houston Chronicle, "West U doctor gets 11 years for Medicare fraud," Terri Langford, 28 October 2011