Federal authorities have charged a prominent Palm Beach dermatologist with healthcare fraud seven months after he paid the U.S. government $5.2 million to settle whistleblower claims that he was “massively” overbilling Medicare.
In court papers filed September 29, Assistant U.S. Attorney Ellen Cohen accuses the dermatologist of defrauding Medicare and TriCare, a federal insurer that serves the military and their families, out of $369,000 from January 2011 through January 2016.
According to the TriCare and Medicare overbilling lawsuit, the insurance companies were informed by the dermatologist that he paid a medical physicist, otherwise known as a radiation specialist, to determine the amount of radiation patients should get during skin cancer treatments. No medical physicist was employed at the healthcare office.
A large majority of the patients who came to that office were diagnosed with squamous cell cancer and ultimately received radiation treatments, falling right into the alleged scheme.
The TriCare and Medicare overbilling lawsuit claims that the files maintained by the dermatologist were also fraudulent and employees were told to respond to all requests for medical records from TriCare or Medicare by creating fraudulent documents known as “make it ready” files. Staff was allegedly instructed to prepare these files immediately when an insurance company reached out for information.
Further, the whistleblower in the Medicare overbilling lawsuit claims that the doctor was also guilty of using a forged signature of a physicist to indicate that such an individual had reviewed and approved the patient files. Such a person was never employed and did not exist. Initials were used to indicate the “physicist” signature.
Whistleblower Key to Government’s Litigation
Federal attorneys filed a TriCare and Medicare overbilling lawsuit against the dermatologist after taking it over a whistleblower lawsuit. The whistleblower was crucial to their case by providing further information about the actual practices engaged in at the healthcare office.
Medicare and Tricare are two prominent federal health insurance programs that have specific regulations and paperwork requirements in place in order for physicians to submit billing details. When individuals or offices attempt to circumvent the rules and overbill Medicare by charging for services never performed, forcing unnecessary tests on patients in order to absorb the insurance money, or engaging in fraudulent practices within the office, the authorities may not know about it until an insider or employee referred to as a whistleblower comes forward.
The dermatology practice in question allegedly went beyond what could have been honest mistakes in overbilling Medicare. The practice is accused of having a non-existent employee sign off on reports ordering services ultimately deemed unnecessary for patients.
The two counts he is facing could lead to a $250,000 fine.
The Palm Beach dermatologist, who operates Allergy Dermatology and Skincare Center in Port St. Lucy and Okeechobee, will be appearing shortly in U.S. District Court to answer those criminal charges of healthcare fraud in addition to obstruction of a criminal healthcare investigation. A maximum 10-year prison sentence applies for healthcare fraud but the obstruction charge also carries a separate 5-year prison term.
Are You Aware of an Overbilling Medicare Scheme?
If you are aware of healthcare fraud, including practices that result in overbilling Medicare or another government-funded insurer, it is strongly recommended that you talk to a whistleblower lawyer. Scheduling a meeting with the whistleblower attorneys at Bradley/Grombacher can help you figure out next steps.
Fill out the form on this page now for a free and confidential case evaluation.