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Primary care physicians among doctors in federal investigations


Feds announce cases – including $43.41 million in bogus billing by surgeon – as regulators hunt for waste, fraud, and abuse.

health fraud gavel money stethoscope: © alexstr - stock.adobe.com

© alexstr - stock.adobe.com

Primary care physicians, a surgeon, and one of New York’s leading opioid prescribers were among the latest doctors involved with investigations by the U.S. Department of Health and Human Services’ Office of Inspector General.

Bad billing for primary care

Two primary care physicians agreed to pay $1.5 million plus interest to resolve False Claims Act allegations they misrepresented the severity of illnesses and services to boost reimbursement from Medicare Advantage and Medicare Part B. The U.S. Attorney’s Office for the Eastern District of Pennsylvania announced the case.

Complete Physician Services (CPS), with Kenneth Wiseman, DO, and Steven Schmidt, DO, of Philadelphia, treated Medicare patients, but from January 2015 to the end of 2018, submitted unsupported diagnosis codes for patients that had a body mass index less than 35, according to the federal lawyers. Additional diagnoses of chronic obstructive pulmonary disease were not medically supported or documented, and the physicians billed for a Current Procedural Terminology Code without requisite levels of decision-making.

“Almost half of Medicare beneficiaries are now enrolled in Medicare Advantage plans. Investigation of credible allegations of fraud impacting it is more important than ever,” U.S. Attorney Jacqueline C. Romero said in an announcement. “The Medicare Advantage Program relies on accurate information about its enrollees’ health status, such as whether they really have morbid obesity or COPD. It is imperative that enrollees receive appropriate treatment and that participating providers and health plans receive proper compensation for the services they actually provide. We will hold accountable those who report unsupported diagnoses to inflate Medicare Advantage payment.”

Surgeries? Not really

A vascular surgeon was sentenced to 80 months in prison and must repay more than $43.41 million for defrauding health care programs for placing vascular stents for thrombectomies he did not perform, according to the U.S. Department of Justice (DOJ).

Vasso Godiali, MD, of Bay City, Michigan, was sentenced this month for defrauding Medicare, Medicaid, and Blue Cross/Blue Shield of Michigan in 2009. This year Godiali entered a plea agreement stating he billed the insurers for services he did not perform. Godiali forfeited about $39.9 million from financial accounts under his control, with the money being used to pay the criminal judgment or settlement under the federal False Claims Act.

“We will not tolerate the use of federal health care programs as a source of personal enrichment,” Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division, said in a news release. The settlement “demonstrates our commitment to protecting the integrity of those programs and the taxpayer funds used to support them.”

Overprescribing Opioids

A former medical doctor will spend 36 months in prison for a conviction of 32 counts of wrongly prescribing oxycodone to 18 patients without a legitimate medical purpose, according to the U.S. Attorney’s Office for the Eastern District of New York.

Frank Parasmo was one of New York state’s 2010 to 2015, when he prescribed more than 1.5 million oxycodone and hydrocodone pills. The charges dealt with the period from January 2014 to February 2015. Parasmo prescribed the drugs to patients who had just left detox treatments, who were discharged from hospitals for overdosing, and who were suspected to be taking illegal drugs or were addicts, according to the U.S. Attorney’s Office.

When Parasmo learned the U.S. Drug Enforcement Agency was investigating, he “cut in half the number of oxycodone prescriptions he issued annually,” a news release said.

“Today’s sentence demonstrates that there are significant consequences for doctors who act as drug dealers,” U.S. Attorney Breon Peace said in a news release. “This office remains committed to using all tools available to address the damage the opioid crisis does to our communities.”

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