September 2, 2015

Things have been getting tighter lately - decreased reimbursement, more paperwork, more competition it seems, probably from those darn urgent care centers that keep popping up...The preceding sentiments are true for many, and some have been taking certain extreme actions to compensate that objectively, I think we can agree, are simply not worth the risk. On August 10, 2015, the NJ US Attorney prevailed against a NJ family practitioner who admitted in open court to billing Medicare for face-to-face encounters that never happened from 2005 to 2014.  During that time, prescriptions were written, refills authorized and fabricated blood pressure readings and other vitals and clinical notes were updated to the patients' charts (according to the press release). The physician admitted that from 2009 to 2013 he gained approximately $280,000 as a direct result of the bogus visits.   

On November 16, 2015, this doctor faces sentencing, which charge carries a maximum penalty of 10 years in prison and a $250,000 fine, or twice the gross gain or loss resulting from the offense.  

So, what happened here?  I do not have additional facts for this case other than the press release, but I can relay there is financial incentive for an employee or patient to have reported this doctor.  A whistle blower receives a percentage of the monies recouped by the government for tattling.  The government also needs information and access to documents and witnesses to build its case.  In all likelihood, and this is complete speculation, this doctor was reported by a patient or staff member (more likely staff member).  

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