Deeper Than the Headlines: Doctor Pleads Guilty to Ordering Medically Unnecessary Brain Scans

Hello, everybody.

Welcome to another video for deeper than the headlines.

In this series of videos, we try to dive a little bit deeper than those regular headlines that we see, about enforcement cases. This means that we typically will look up the complaint or the charges, in any court records that are available. We try to dig a little bit deeper just to try to find a little bit more information, about what might have been going on. So the case we wanna share with you today, has to do with a seventy five year old New York, physician. He pleaded guilty in federal court, for receiving kickbacks to order medically unnecessary brain scans.

So this doctor was an internist, who practiced for forty seven years and conspired with a person from who worked for a mobile medical diagnostics company.

And this company performed transcranial Doppler ultrasounds.

And what's interesting in this case is that the, charging documents refer to the LCD, for this region.

So, you know, transcranial Doppler ultrasounds are used to, to assess, the vessels in the in the brain, blood vessels in the brain. And, this LCD that existed for this region only had, like, eight or nine diagnosis codes that, would allow or that would, be considered medically necessary.

And so what what happened here, excuse me, is that, the doctor was given a hun about a hundred dollars per test. So every transcranial Doppler ultrasound that that he ordered, he would be given about a hundred dollars.

And the, the deal was that, you know, they he would document, a false diagnosis code. So, of course, for these claims to be paid, by Medicare, you have to have a diagnosis code that is on the LCD.

Otherwise, when the claim processes processes, the the claim would be kicked out. So, using those diagnosis codes, but the patient didn't really have those conditions.

So interesting as I as I read through some of the the court records, it it they totaled the total payments or kickbacks to this one doctor was about forty eight thousand dollars, and it resulted in about, nine hundred thousand dollars in, fraudulent bills that were submitted. And one of the things that I found interesting is, they talk in the in the, in the court records about how cash kickback payments were given, so how the money was actually given.

And they shared one of the text messages that, was sent from the, person who worked for the medical diagnostics company to the doctor, informing the doctor's office saying, quote, or I should sorry. That the doctor should, quote, write TCD, that's the transcranial Doppler ultrasounds, for migraines and headaches, which is transient cerebral ischemia on the exam request.

Also, SSR for all diabetics, they have the same value as a carotid, ninety three versus one hundred and forty last month.

So it's just interesting how, you know, emails and and texts and and other things are often used, to demonstrate, right, that there was a intent here to pay kickbacks.

And, as as we've talked about in other, videos, we've seen, at least anecdotally, that the enforcement against the actual receiver of the the kickback is also being, subject to enforcement. Historically, what we've seen, you know, ten, twenty years ago, it was predominantly, at least in the press releases that were released, predominantly the, the company or the entity that was giving the kickback or offering the kickback. And we're seeing a whole lot more, charges and enforcement against those who take the kickback or ask for a kickback. So we will include a link to the press release on on this case, and, you can you can read it. Hope you find it interesting.

And until next time, take care.

Reference link: https://www.justice.gov/usao-ma/pr/new-york-doctor-pleads-guilty-health-care-fraud

P.S. This transcript has been auto-generated. Please forgive any typos or grammatical errors.