The government alleged that the physician’s medical records did not support his claims for Medicare reimbursement. The patient records did not contain the detailed history, examination, and medical decision-making documentation necessary to justify reimbursement. In some instances, there was no documentation at all.
The government also alleged that the patient records did not accurately describe where the treatment was rendered. In some instances, the physician's records indicated that services were provided to patients in nursing homes, while other records indicated that the patients had been transferred to local hospitals for treatment.
Claims submitted to Medicare or Medicaid must be supported with proper documentation. The patient records must establish that the treatment met the Medicare "medical necessity" requirements and was actually provided by the appropriate medical professional. Absent that documentation, the claims may be considered “false claims” under the federal False Claims Act, even if the services were actually provided and medically necessary.
False Claims Act penalties include liability for three times the amount the government paid, plus $11,000 per claim. If the government can prove that the submission of false claims was intentional, it may pursue criminal charges that can result in up to five years in prison, hefty fines, exclusion from Medicare and Medicaid, and loss of professional licenses.
If you are being investigated or have been charged with filing false claims to Medicare or Medicaid, then you should consult with an experienced Medicare and Medicaid fraud attorney immediately to protect your rights, your license, and your livelihood. Do not speak with the government until you have retained an experienced lawyer on your side.
To arrange a free and confidential consultation with an experienced Medicare and Medicaid fraud attorney, call John Howley, Esq. at (212) 601-2728 or click here to reach our office via email.
John Howley, Esq.
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