Medicare Compliance & Reimbursement
DOJ Gives a Hefty Sentence to a Michigan Physician with a Trifecta of Fraud Charges
Most offenders of Medicare fraud fall into categories of severity, which render the perpetrators guilty of either civil or criminal actions. It is a rare circumstance when a physician breaks laws across states, both civilly and criminally, losing medical credentials in the process.
A Michigan physician was found guilty of falsifying documentation, improperly billing payments under the False Claims Act, and violating the “federal Controlled Substances Act in his treatment of patients for pain and substance use disorders by prescribing patients a combination of at least one opioid, one benzodiazepine, and carisoprodol (a combination colloquially referred to as the “Holy Trinity” for its rapid euphoric effects) on several occasions,” in addition to other drug offenses, a Department of Justice (DOJ) news release from Oct. 24, 2016 suggested.
His settlement included three years of probation, a plethora of fines, a criminal settlement equaling $172,991, a civil settlement of $273,496, and the surrender of the physician’s medical license and DEA registration.
“Document frauds in the health care field are particularly damaging because insurers rely on the accuracy and presume the authenticity of documents to assess the legitimacy of health care claims,” said Patrick Miles, U.S. Attorney, in the DOJ release. “As for improper prescribing of controlled substances, our opioid epidemic warrants the serious attention we give those allegations.”
For a closer look at the DOJ briefing, visit https://www.justice.gov/usao-wdmi/pr/2016_1024_DeWeese.
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