Provided by: Jennifer Kirschenbaum, Esq.
November 5, 2024
Big day today, so good day for a distraction newsletter! New news, and some fake news -
1. The big headline - "Doctor Sentenced for $54M Medicare Fraud Scheme" The real real - according to the limited press release, once you keep reading, the MD in question received $466k in kickbacks ($30 per order) to sign DME authorizations and cancer genetic test orders, allegedly not legitimately prescribed, not needed or not used. From the ordering completed, $54MM in false claims were allegedly submitted tor Medicare reimbursement. The MD plead guilty to conspiracy to commit wire fraud and was sentenced today to 10 years and one month in prison and ordered to pay over $34 million in restitution for his role. So, fake news here is the misrepresentation that the MD benefited by way of millions of dollars for his role in this alleged conspiracy; in fact, the MD benefited less than $500k. More fake news is the allegation the orders were not legitimate, not needed or not used - these allegations were never proven at a trial because the MD took a plea deal, which is pretty common.
2. The big headline - "North Carolina Physician and Medical Practice Agree to Pay $625,000 to Settle Kickback Allegations" Buried in the press release from the DOJ, the medical practice received payments for phlebotomy services, rental of office space and lease of a chemistry analyzer machine that were allegedly kickbacks for referrals to the renting laboratory from 2015 to 2021. I chose this press release because many independent practices at some point consider a rental arrangement with a related practice or ancillary service provider. The amounts paid are not broken down. What we do know is there is a settlement in this instance - $625k - not broken down in an explanatory way - what amount is refund for payments made v. treble damages, etc. or potentially amounts paid as rental payments. Over a 6 year period, that amount does not sound outrageous for staffing and equipment... Tough to really discern here with the info disclosed.
In both of the above examples the MD chose to add an ancillary service line, which happens all the time (DME ordering, incorporating a lab). Reminder to deploy a complete and robust diligence assessment (with competent counsel assistance) before signing on to any ancillary arrangement or new employment, because the juice may not be worth the squeeze.
1. The big headline - "Doctor Sentenced for $54M Medicare Fraud Scheme" The real real - according to the limited press release, once you keep reading, the MD in question received $466k in kickbacks ($30 per order) to sign DME authorizations and cancer genetic test orders, allegedly not legitimately prescribed, not needed or not used. From the ordering completed, $54MM in false claims were allegedly submitted tor Medicare reimbursement. The MD plead guilty to conspiracy to commit wire fraud and was sentenced today to 10 years and one month in prison and ordered to pay over $34 million in restitution for his role. So, fake news here is the misrepresentation that the MD benefited by way of millions of dollars for his role in this alleged conspiracy; in fact, the MD benefited less than $500k. More fake news is the allegation the orders were not legitimate, not needed or not used - these allegations were never proven at a trial because the MD took a plea deal, which is pretty common.
2. The big headline - "North Carolina Physician and Medical Practice Agree to Pay $625,000 to Settle Kickback Allegations" Buried in the press release from the DOJ, the medical practice received payments for phlebotomy services, rental of office space and lease of a chemistry analyzer machine that were allegedly kickbacks for referrals to the renting laboratory from 2015 to 2021. I chose this press release because many independent practices at some point consider a rental arrangement with a related practice or ancillary service provider. The amounts paid are not broken down. What we do know is there is a settlement in this instance - $625k - not broken down in an explanatory way - what amount is refund for payments made v. treble damages, etc. or potentially amounts paid as rental payments. Over a 6 year period, that amount does not sound outrageous for staffing and equipment... Tough to really discern here with the info disclosed.
In both of the above examples the MD chose to add an ancillary service line, which happens all the time (DME ordering, incorporating a lab). Reminder to deploy a complete and robust diligence assessment (with competent counsel assistance) before signing on to any ancillary arrangement or new employment, because the juice may not be worth the squeeze.
Have a question for Jennifer? Email is best. You can reach her at Jennifer@Kirschenbaumesq.com.
