Blowing the Whistle on Fraud

7
54221462 - medical syringe in the doctor's hands on the patient's background.

It pays to be a whistleblower, especially for health care professionals who want to stop fraud, waste and abuse within the Medicare benefits program. Whistleblowers are entitled to earn a significant financial reward for reporting fraudulent crimes against the government within the health care industry. An article posted on WTSP.com describes a lawsuit brought against a Tampa doctor, and the whistleblower’s reward for reporting the doctor’s fraudulent Medicare billing practices.

The story states that the Tampa Bay area doctor owned and operated both a vein clinic and a weight loss clinic. In a lawsuit filed by the doctor’s former office manager, she alleged that the doctor texted messages to her with instructions to perform varicose vein injections on patients while he was not in the office. (That’s a scary thought.) It was also alleged that when the doctor was in the office, he often performed unnecessary vein injections and ultrasound imaging procedures related to the injections. He then billed the procedures to Medicare. He also used his own Medicare provider number to bill Medicare for office visits that were performed by unqualified personnel.

The two offices were closed and the doctor entered into a three-year Integrity Agreement with the Office of Inspector General of the Department of Health and Human Services. This agreement requires him to attend training courses administered by the Centers for Medicare and Medicaid Services. His federal health care program coding and billing procedures will also be reviewed. (Let’s hope he gets it right the second time around.)

U.S. laws now allow people reporting Medicare fraud to receive full protection from retaliation. Whistleblowers can receive up to 30 percent of the fines collected by the government. In this particular case, the doctor is required to pay $400,000 for his fraudulent billing practices, while the office manager will receive $72,000 for bringing attention to the crime. It just goes to show that in the end, the doctor’s crime did not pay off for him, while the office manager’s honesty did pay off for her. (Honesty is always the best policy.)

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Owner of 2 Tampa Vein Centers, Dr. Ravi Sharma, Agrees to Lawsuit Settlement,” published by WTSP.com on January 7, 2014.

TAMPA – A Bay area doctor will pay $400,000 in a False Claims Act settlement with The Department of Justice for knowingly billing Medicare for vein injections and physician office visits performed by unqualified personnel.

The government alleged that, between 2009 and 2010, Sharma owned and operated a clinic in the Tampa area called Premier Vein Centers.

Read More

SHARE
Previous articleFraud Chain
Next articleOut of Desperation
Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.