Follow the Rules!

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It’s not uncommon for healthcare providers to get caught not following healthcare laws regulating prescription medications and billing to Medicaid and Medicare. And when they do, the penalties are often steep. An Ashland, K.Y., physician learned this the hard way after settling civil claims that she, and the substance abuse treatment center she’s affiliated with, violated the federal Controlled Substances Act and defrauded the federal Medicare and state Medicaid programs.

The doctor, who was an addiction treatment specialist, and Ultimate Care Medical Services LLC, agreed to pay $1.4 million to resolve the case with the U.S. Department of Justice. The complaint alleged that the doctor and clinic billed Medicare and Medicaid for services between January 2013 and September 2014 that were never provided.

The programs were billed for “evaluation and management” services for patients who received daily methadone doses at the clinic. Reimbursement requires a patient exam, patient history, medical decision-making, and complex urine drug-testing, which the government says didn’t happen. (The clinic didn’t even have the equipment to do such tests). In fact, the case alleges, the clinic falsified patient records to make it appear the requirements were met.

The claim further alleges that the doctor prescribed buprenorphine (under the brands Suboxone and Subutex) to more patients than is legally permitted. (And that she did so repeatedly.) There was no determination of liability as part of the settlement.

Doctors prescribe buprenorphine in the treatment of opioid addiction. Kentucky has been central in the nationwide opioid epidemic and is known to have the third-highest death by drug overdose rate in the country.

Tips about potential fraud, waste, abuse, and mismanagement can be reported to the U.S. Department of Health and Human Services, at 800-HHS-TIPS (800-447-8477).  Tips about possible violations of controlled substances laws can be reported at www.dea.gov/submit-tip.

Today’s Fraud of the Day comes from the U.S. Justice Department press release, “Ashland Physician and Substance Abuse Treatment Center Agree To Pay $1.4 Million to Resolve Civil Claims,” released Aug. 16, 2019.

ASHLAND, Ky. – An Ashland addiction treatment specialist, Dr. Rose O. Uradu, and her substance abuse treatment center, Ultimate Care Medical Services, LLC d/b/a Ultimate Treatment Center, have agreed to pay $1.4 million to resolve civil allegations that they violated the Controlled Substances Act, and defrauded the Medicare and Kentucky Medicaid programs.

This settlement resolves a civil lawsuit alleging that Ultimate Treatment Center, at the direction of Dr. Uradu, sought and received payments from Medicare and Kentucky Medicaid for services that were not actually provided to patients.  According to the Complaint, between January 2013 and September 2014, defendants billed these government programs for “evaluation and management” services, purportedly provided to patients who visited the clinic to receive daily methadone doses.  To be reimbursed by Medicare and Kentucky Medicaid, evaluation and management services should include performance of an examination of the patient, a patient history, and medical decision-making.  The United States alleged that Ultimate Treatment Center did not actually perform these services when patients received their methadone doses, but falsely documented the performance of these services, in the patients’ medical records, in order to create the false appearance that the reimbursement was justified.

 

 

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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.