Deeper Than the Headlines: 'Impossible Days'

‘I just wish there were more time in the day.’ 

This is a statement many of us have probably said a hundred times. But, according to court documents and allegations from a whistleblower employee of a New York dermatologist, a Dr. Barry Solomon was able to find 26 hours in a 24-hour day, or at least that is what he allegedly billed for. The Department of Justice referred to this type of billing as “impossible days” alluding to the fact that no one can possibly bill for more time in a day than 24 hours.

The court documents allege that Dr. Solomon regularly billed for seeing 120-150 patients a day, claiming that he spent 15 minutes with each patient. However, the whistleblower stated that he only spent a couple minutes with each patient.

This is one of the many allegations claimed in the lawsuit brought by the employee whistle blower. The Department of Justice announced on July 27, 2016 that Dr. Solomon has settled the suit. He agreed to a 3-year corporate integrity agreement and to pay over $300,000 to resolve claims. 

One of the allegations was upcoding, or reporting higher reimbursable codes, when lower reimbursing codes were more appropriate. Upcoding can be found in all medical specialties but in this particular case the issue surrounded the codes used to report wound closure. After a skin cancer lesion or cyst is removed, the remaining wound needs to be closed. There are various levels of complexity for these types of closures. It was alleged that Dr. Solomon reported the higher reimbursed codes of “adjacent tissue transfer” (CPT codes 14000, 14020, 14040 or 14060) instead of the more appropriate (and lower reimbursed codes) of 12001-12021, 12031-12057 or 13100-13160. Court records included exhibits of 15 operative reports which included a templated, almost “canned” report with blanks that could be filled in.

“Time is money,” and one of the allegations made included ways to get more done but bill at higher reimbursement levels. Specifically, to create more time in the day it was alleged Dr. Solomon’s physician assistants would perform the initial patient consultations on new patients but the bills were reported as if Dr. Solomon himself saw the patients. Reimbursement is higher if it’s reported that the doctor saw the patients and performed the service as opposed to the physician assistants who actually performed these services according to the whistleblower. The alleged evidence showed bills that had been submitted as if Dr. Solomon performed the service on days he was not in the office and occasionally not in the country.

Dermatologists prescribe a lot of medications. Any patient expects his or her doctor to prescribe medications based on what is best for them, not what is best for the physicians pocketbook. It was alleged that Dr. Solomon allowed financial payments, or kickbacks, from pharmaceutical companies to influence his prescribing practices in violation of the anti-kickback statute.

The whistleblower alleged that Dr. Solomon and his wife were taken to lavish dinners, paid for by the pharmaceutical companies. The dinners were supposed to be “lectures” with many other physicians attending but court records indicated that the “lectures” were just a cover and no other physicians were in attendance. As an attempt to make it appear like more physicians were in attendance, it was alleged that the pharmaceutical representatives would inflate the final bill by buying gift cards that were handed to Dr. Solomon. 

In another instance, it was alleged that a pharmaceutical company paid for Dr. Solomon and his wife to take a trip to Charleston, S.C. where their food, travel, hotel and tickets to a football game were covered by the pharmaceutical company.

Other allegations in this regard included daily lunches, brought to the office by pharmaceutical sales representatives. Just for the year of 2013, it was alleged that the value of these daily lunches excessed $30,000. Additionally, it was alleged Dr. Solomon was regularly paid $2,000-$3,000 to perform ‘lectures’ which never really occurred but turned out to be dinners for him and his wife. Reportedly, he even recorded and sought reimbursement for mileage to and from these “lectures.”

He was allegedly paid $50.00 for each prescription he wrote from one pharmaceutical company in particular. In total, he allegedly received over $342,000 in kickbacks. Upcoding, billing for services in the name of the physician, and accepting kickbacks are activities that are not necessarily unique to dermatology, but by reading the court documents you can get specifics that demonstrate these activities. This particular case included almost 100 pages of allegations and supposed evidence, including operative reports, billing records and lists of check numbers and transactions connected to alleged kickbacks. 

The more specifics you have from the story, the better equipped you’ll be as you try to bolster your compliance program to avoid the same or similar missteps in your organization.