Physician Behavior and Compliance Implications

Last year two doctors in Long Island, Dr. Vikas Desai, and Dr. Robert Maccone, entered into separate civil settlement agreements where they agreed to pay the United States a total of $1,120,299 dollars to resolve allegations that they submitted false claims to Medicare for medically unnecessary nerve conduction studies.

The allegations included:

• Altered documents so it would appear studies were done on different days, even though tests were done on the same day.
• Tests were not medically necessary.
• The staff was compensated for administering multiple tests to multiple patients.

The investigation began when Rosemarie Hennessey, the receptionist at EIFC, the doctor’s place of practice, filed a complaint on behalf of the United States. A private individual who has uncovered fraud against the federal government is able to file a suit in a federal court on behalf of the USA, under the False Claims Act. If the United States recovers the money, Hennessey may receive a percentage of the recovered amount.

Protecting your organization starts with an all-encompassing compliance program. Is your compliance program physician-focused?

What you can do to protect your organization:

• Compliance Program Effectiveness Review: With the passage of the Patient Protection and Affordable Care Act of 2010, physicians who treat Medicare and Medicaid beneficiaries will be required to establish a compliance program.
• Some auditing and monitoring should be done by someone who has been medically trained: The individuals from the physician practice involved in self-audits should ideally include a person involved in billing and a medically trained person such as a nurse or preferably a physician.
• Manage Compliance: Leverage experts, document a pattern of thoughtful compliance, and utilize compliance tools that will allow you to effectively implement and track your program.

A successful compliance plan can prevent a potential PR nightmare and monetary disaster.