Practice Management Alert

Think over-ordering isn't something to take seriously? Think again, says a recent court case that resulted in Tenet Healthcare Corp. paying out $54 million, the largest sum ever recovered in a case involving medical-necessity fraud.

The case centered on unnecessary invasive coronary procedures - including heart catheterization, angioplasties and open heart surgeries - that were performed at Redding Medical Center between 1997 and 2002, then billed to Medicare and other government healthcare programs.

According to U.S. attorney McGregor Scott's office, a physician at Redding performed a cardiac catheterization on the Rev. John Corapi and then recommended immediate, multiple-vessel heart bypass surgery. Corapi was suspicious and sought second opinions from physicians outside of Redding who advised against the surgery. When Redding Medical Center failed to address complaints, Corapi and one of his colleagues contacted the FBI, which launched the investigation.

Tenet Healthcare Corp. announced in December that it would sell Redding Medical Center rather than allow the facility to be excluded from government health programs. Criminal charges have not been filed in the case, which is ongoing.

Lesson learned: This high-profile case of a patient turning into a whistleblower illustrates the importance of maintaining an aggressive compliance program and being a watchdog for your practice.