Physician Fraud Cases
The United States Attorney’s Office
Southern District of Texas
August 6, 2007
LOCAL PHYSICIAN SENTENCED TO PRISON FOR DEFRAUDING INSURANCE COMPANIES OF $10 MILLION
(HOUSTON) Dr. Ira Klein, a physician who specialized in treating Hepatitis C patients, has been sentenced to more than 11 years in federal prison, without parole, for health care and mail fraud, United States Attorney Don DeGabrielle announced today.
Any test which doctors provide themselves (self-referral) is an opportunity for fraud. To identify suspect cases, measure the number of tests per 1,000 patients for doctors performing the test themselves, compared to those who refer patients to another provider. You may need to make adjustments for patient diagnosis or health status.
Of course looking to evidence is most important. Are these doctors qualified to perform the service? Is the diagnostic test effective as a screening tool or should its uses be more limited? Does the test result in more treatment? Is the treatment effective?
Here are some highlights from an article from the New York Times about a product with high fraud potential:
A Lafayette doctor is at the center of a major federal investigation.
Cardiologist Mehmood Patel has been indicted on 94 counts of healthcare fraud involving 94 different patients.
The indictment alleges Dr. Mehmood Patel performed unnecessary heart procedures at Our Lady of Lourdes and Lafayette General.
CLEVELAND — A doctor was convicted of health care fraud and other charges for prescribing painkillers that prosecutors say resulted in the deaths of two patients under his care.
Dr. Jorge Martinez contends his clinics in Parma and Boardman in northeast Ohio offered people relief from chronic pain.
Press Release from: McGregor W. Scott, United States Attorney, Eastern District of California
FOR IMMEDIATE RELEASE Contact: Patty Pontello, 916-554-2706
November 15, 2005
DOCTORS ACCUSED OF PERFORMING UNNECESSARY HEART SURGERIES AT REDDING MEDICAL CENTER AGREE TO PAY MILLIONS TO SETTLE FRAUD ALLEGATIONS AND ACCEPT RESTRICTIONS ON THEIR MEDICAL PRACTICE
- The Agreement Preserves the Right to Revoke the Doctors’ Licenses and Exclude Them From the Medicare Program.
Dr. Joseph Olstein helped the government get a $1.2 billion settlement from TAP Pharmaceutical and AstraZeneca. In return he received only a light sentence for his part in the scam. The US Attorney announced that Olstein was sentenced this week to one year probation and a $20,000 fine (in addition to a previous $50,000 restitution payment).
Dr. Olstein pleaded guilty in 2001 to billing insurance companies for free samples of Lupron, which he received from TAP sales people. Lupron is an injectible drug used for treating prostate cancer. Physicians can bill Medicare and other insurers for injectible drugs. Because the free samples were given as a way for physicians to enhance their income, the samples are considered a kick-back. Without the kickbacks that TAP offered to urologists, an equivalent drug that is cheaper than Lupron would probably have been prescribed.
A New Jersey neurologist was charged with health care claims fraud in June, 2003. Barry M. Vogel allegedly submitted more than $54,000 in healthcare insurance claims for tests and other services that were not provided. Vogel allegedly submitted false claims to Prudential Property & Casualty Insurance Company for electro-diagnostic tests and nerve conduction velocity tests.
Dr. Aubrey Camacho, an obstetrician in Georgia, made his living ripping off Medicaid. To get higher reimbursement, Camacho billed Medicaid for Caesarean deliveries when he performed vaginal deliveries. He billed for patients who didn’t even know who he was and for seeing patients when he was not in the office. He also billed Medicaid for sonograms that were not provided or were not medically necessary, including 92 sonograms for one patient.