Legal Services for Dermatology Practices
Health care fraud can affect all medical professionals and medical offices. Dermatologist offices and practices are not immune to charges of fraudulent conduct.
Health care fraud is comprised of several different schemes and plans, most with the aim of receiving money and medical goods from insurance companies based on false or fraudulent information provided by a medical office.
Charges of health care fraud can ruin a medical practice’s or a medical professional’s reputation and career.
What Types of Dermatology Professionals Can Be Accused?
Specifically, in dermatology practices, the following professionals can be harmed from allegations of health care fraud:
- Dermatologists
- Cosmetic Surgeons
- Physician Assistants
- Aestheticians
- Nurse Practitioners
- Nurses
- Nursing Aides, and
- Support Staff, including receptionists, human resource employees, and billing employees
Call 844-239-1234
for a Free Confidential Consultation
Those who are licensed medical professionals may lose their license to practice medicine along with the many other consequences discussed in further detail below.
What Laws Comprise Health Care Fraud?
In the United States, health care fraud encompasses a combination of several laws and regulations.
These laws and regulations include:
- Criminal Health Care Fraud (18 U.S.C. §1347)
This statute aims to punish individuals who knowingly and willfully execute, or attempt to execute, any scheme that would defraud a health care benefit program of any money or other property under the control of that program. Those convicted of these crimes face up to 10 years in prison and up to 20 years if someone dies as a result of the fraud. Plus, they could face fines of up to double the amount received as a result of the fraudulent scheme. - The False Claims Act (31 U.S.C., Chp. 37)
This statute is used to prosecute those medical professionals who knowingly and willfully file fake claims to insurers to get payment in return. For example, if a dermatologist bills a patient’s insurance company for services that were never actually provided to that patient, that dermatologist may be charged with fraud under the False Claims Act. Convictions lead to a fine of between $5,000 to $10,000, plus a return o f payments up to 3 times the amount that the government was defrauded of as a result of the scheme. - The Anti-Kickback Statute (42 U.S.C. § 1320a-7b(b))
This statute makes it illegal for someone to make a knowing and willful payment in order to reward people or companies that make patient referrals or the generation of business involving any item or service payable by the federal healthcare programs, such as Medicare.For example, if a dermatology clinic pays a general practitioner to refer patients with Medicare to visit its clinic for their problems with eczema, that would be in direct violation of this law. If you are found guilty of violating the Anti-Kickback statute you face fines of up to $25,000, a prison sentence of up to 5 years, or a combination of both. - The Physician Self-Referral law (Stark Law) (42 U.S.C. § 1395nn)
The Stark Law is aimed at punishing those doctors who refer patients to receive specialized medical care from any facility or business that the doctor, or any member of the doctor’s immediate family, has some financial interest in. For example, if a dermatologist recommends that their patient needs some type of radiology imagery service, like an MRI, and makes a referral to an imaging center owned by that dermatologist’s brother, that violation might be in violation of the Stark law. Other statutes that if violated would be considered health care fraud includes the Exclusion Statute (42 U.S.C. § 1320a-7).
Dermatology Practices and Health Care Fraud in the News
Article 1: Chicago Dermatologist Convicted on Federal Fraud Charges for Billing Health Insurance Programs for Medically Unnecessary Treatments
On May 2017, a federal jury convicted Dr. Omeed Memar of 16 counts, including eight counts health care fraud.
According to court documents, from about 2007 to 2013, Dr. Memar filed erroneous claims to several different health insurance companies stating that certain treatments for a precancerous condition were medically necessary.
The court found that Dr. Memar knew that these treatments were not necessary and that he had faked his patients’ diagnoses.
The patients who were purportedly treated for the precancerous condition testified at trial that they were never told about this diagnosis. Further, they testified that they had not received any of the billed-for treatments.
For more information and for the full Department of Justice (DOJ) press release, click this link or copy and paste the URL below.
Article 2: Florida Dermatologist Agrees to Pay $2.5 Million to Resolve Allegations of Billing Fraud
In May 2018, Tim Ioannides, M.D. agreed to pay $2.5 million to resolve allegations that he violated the False Claims Act by billing Medicare for procedures that he did not perform.
Between 2010 and 2016, it is alleged that Dr. Ioannides billed for muscle flap procedures that he did not actually perform. As a result, from 2011 to 2013 Dr. Ioannides was the highest paid physician in the United States for the procedure.
It was also alleged that Dr. Ioannides was upcoding, or charging for more treatments than actually performed, for services like cryotherapy.
The suit was filed by a former patient of Dr. Ioannides as a Qui Tam suit and was then taken over by the United States government.
For more information and for the full DOJ press release, click this link or copy and paste the URL below.
Article 3: Dermatology Physicians and Practice to Pay $1.9 Million to Settle False Claims Act Investigation into Overbilling Medicare for Evaluation and Management Services
In April 2016, an Atlanta-based dermatology practice group reached a $1.9 million settlement for claims that they had violated the False Claims Act.
Two of the doctors at the practice were billing for both evaluation and management services as well as procedures on the same day. This is not allowed under Medicare’s program regulations unless certain criteria is met. They failed to fulfill the requirements of Medicare.
The practice of billing for evaluation and management services on the same day as a procedure is estimated to cost the taxpayers who fund the federal health insurance programs billions of dollars each year.
For more information and for the full DOJ press release, click this link or copy and paste the URL below.
Article 4: Encino Dermatologist Pays Nearly $2.7 Million to Resolve Allegations He Billed Medicare for Unnecessary Mohs Skin Cancer Surgeries
On April 2017, The Skin Cancer Medical Center in Encino, California agreed to pay out nearly $2.7 million in relation to allegations that it was billing Medicare for unnecessary Mohs surgeries.
The suit was brought by a former employee of the medical center and was ultimately settled by the United States Government.
The suit alleged that Dr. Norman A. Brooks was falsely diagnosing skin cancer in some of his patients in order to perform, and bill for, the Mohs surgeries.
Since Mohs surgeries are required to be done in steps and are rather complex, they yield a higher payout from Medicare than other procedures that can be used to remove skin lesions.
As a result of the settlement, Dr. Brooks agreed to a three-year integrity agreement. This agreement means that Dr. Brooks will still be able to see and treat patients but must establish and maintain a compliance program that includes proper office-wide training on Medicare and Medicaid billing procedures.
For more information and for the full DOJ press release, click this link or copy and paste the URL below.
Defenses
A trial can be won or lost based on the experience of defense attorneys, the defense strategy they employ, and the expert testimony they utilize (or debunk).
An experienced defense attorney will be able to craft a defense strategy that is tailored perfectly to your individual case, needs, and interests.
Below is just one of many potential defenses that a knowledgeable attorney may choose to base your defense strategy on.
Lack of Necessary Intent or Knowledge
One of the biggest things the prosecution needs to prove in any health care fraud case is that the defendant acted knowingly and willfully when providing fraudulent information to an insurance provider.
If the wrong billing code was submitted or a procedure that had not been performed was billed for simply out of human error, then the necessary intent required for a conviction of health care fraud is not present.
In addition, if an employee is acting at the direction of a doctor or other “higher-up”, and they submit an incorrect billing code or provide a false diagnosis for billing, they can argue that they should not be held liable. The employee in this case would have no reason to know of the fraudulent conduct and thus cannot be convicted of fraud.
On the other hand, the person who instructed the employee to act may be held liable for fraud, even if they did not perform the fraudulent act themselves.
Speak With a Healthcare Attorney You Can Trust
Call 844-239-1234
If you are a dermatologist, or work in any capacity in a dermatology practice or office, contact an experienced health care attorney as soon as possible if you believe you are the subject of a health care fraud investigation.
An attorney will be able to guide and advise you through every step of an investigation and trial. In addition, a knowledgeable attorney will also ensure that your right and interests, as well as the rights and interests of your patients, are protected at every stage of the proceedings.