Medicare Compliance & Reimbursement

House calls can pay — but they can also raise red flags if you’re billing them excessively. That’s what one Texas physician discovered recently, when the Department of Justice (DOJ) charged him with health care fraud.

The doctor and his employee were arrested on May 8 for their suspected roles in a scheme that cost the government over $5 million. The DOJ alleged that the doctor billed home visits as if he personally performed them, but actually sent his employee (a non-physician) to do them and was not present when the visits took place. In addition, some of the claims were for dates of service when the doctor wasn’t even in the U.S.

The physician and his staffer have not yet entered a plea in the case, but it underscores the importance of documentation that proves the doctor is actually with the patient when he says he is. If a non-physician staff member is performing visits in lieu of the doctor, you must bill under the staff member’s number and clearly indicate that in the records.

Resource: To read more about the case, visit www.justice.gov/opa/pr/dallas-physician-and-his-employee-arrested-alleged-52-million-medicare-fraud-scheme.