August 14: Week That Was in Healthcare Fraud and Malpractice
By - Here is a general roundup of the past week’s developments in healthcare fraud and malpractice, as reported by the Department of Justice and the Office of Inspector General. The crimes reported below result in multiple millions of dollars in healthcare fraud and the possibility of extensive prison time.
Former Louisiana chiropractor guilty for healthcare fraud
David Lee Killen of Covington, Louisiana, the owner and operator of chiropractic clinic Back on Track Clinic, LLC, was sentenced this week after previously pleading guilty to healthcare fraud. Killen, currently in state custody serving 60 months on domestic abuse battery charges involving strangulation, was sentenced to 44 months imprisonment and 3 years of supervised release. Killen was ordered restitution of over $183,000 to five different insurance companies.
According to court documents, Killen billed healthcare insurers for chiropractic services, back braces, and X-rays that were not actually provided. Additionally, Killen billed insurers for costly allergy test and the antigen leukocyte antibody test known as “ALCAT.”
According to the Department of Justice, Killen either did not render ALCATs or made exchanges for co-payments decreases or nullified co-payment balances if a patient concurred to a test. Additionally, Killen fraudulently billed insurers for services using unauthorized physician provider numbers or times when physicians were not present within the clinic.
Oswego Hospital, physician pay $1.5M to resolve liability
Oswego Hospital in Oswego, New York will pay nearly $1.5 million to resolve False Claims Act liability tied to healthcare billing improprieties self-disclosed by the hospital to the federal government.
According to the Department of Justice, “Oswego identified claims that were paid by federal and state payors where the supporting medical record documentation: (1) was not created or could not be located; (2) contained incorrect service dates; (3) were simply verbatim treatment notes from prior appointments with patients; and/or (4) failed to include time-related information required for certain time-based billing codes.”
Oswego was required to pay a much smaller amount than the treble damages and penalties due to its decision to self-disclose. The Department of Health and Human Services’ Office of Inspector General (HHS-OIG) decided Oswego does not have to enter a corporate integrity or adopt other compliance measures.
“Our office is committed to ensuring that federal health care programs and their beneficiaries receive the services for which the government pays,” says United States Attorney Richard S. Hartunian. The settlements in this investigation demonstrate how voluntary self-disclosures benefit both the integrity of the health care programs and the providers who discover and report improper billing in their organizations. Oswego should be commended for the manner in which it handled the disclosure and investigation,” he adds.
Says Attorney General Eric Schneiderman, “This settlement illustrates the importance of hospitals being mindful of billing requirements for government-sponsored healthcare. Through its cooperation with the investigation and return of Medicaid funds, Oswego Hospital demonstrated its accountability and commitment to abide by government healthcare rules and regulations and uphold the highest standards of integrity.”
