A recent investigation into healthcare fraud has demonstrated to the providers of health care, three major reminders that are as follows:
The federal government takes the accountability of health care providers very seriously and it was not joking around at the time of the statement of fraud and abuse laws.
The enforcement efforts of the government not only focus on the chains of large hospitals but also the physician groups.
Providers must keep in mind that their employees could also be instigating the actions of the government.
Baldwin Bone & Joint, P.C. (BB&J), a practice of orthopedic surgery as well as physical therapy in Daphne, Alabama, has committed to pay 1.2 million dollars to the federal government as the consequence of a settlement that arose out of the allegations that BB&J had violated many laws, including the federal physician self-referral law (the Stark Law); the federal False Claims Act; and the federal Anti-Kickback Statute (the AKS).
The case was filed by one of the former exercise physiologists of BB&J. That case called for a federal investigation by the United States Department of Health and Human Services’ Office of Inspector General and the Defense Criminal Investigative Service as there were also allegations involving the TRICARE patients.
According to the lawsuit, BB&J had billed Medicare and TRICARE for some physical therapy services that were not performed by authorized providers. These unauthorized providers involved some athletic trainers as well as an exercise physiologist. The complaint also said that the internal compensation plan of BB&J violated the Stark Law as the physicians were compensated depending on the volume of patients that they referred to internally for designated health services like physical therapy, MRIs, and X-rays.