Both federal and state attorneys general have been focused in the past two years on cracking down on doctors, hospitals and other health care providers that commit Medicare fraud.
Just recently, the Charlotte Observer reported that several doctors working at a for-profit hospital have alleged the owner offered them illegal kickbacks to order unnecessary tests on patients and admit more of them so that the hospital could bolster its corporate revenues. Two of the doctors have filed a lawsuit in U.S. District Court in Charlotte against Mid-Atlantic Emergency Medical Associates – the fourth-largest for-profit hospital chain in the country.
Additionally, the U.S. Department of Health & Human Services, alongside the U.S. Department of Justice, lists numerous Medicare fraud arrests that have occurred over the last five years in North Carolina.
Beyond the criminal implications of these cases, our Asheville medical malpractice attorneys recognize that some of these cases may additionally warrant civil lawsuits filed by patients, upon whom unnecessary – and potentially dangerous – tests and procedures were conducted.
Patients may be willing to assume a certain degree of risk for testing or surgical procedures if they feel the benefits outweigh the risks. However, in cases of Medicare fraud, there may be evidence that those risks were overstated simply so that the health care provider could collect a government check – not because such procedures were in the best interest of the patient’s health.
A good example of this was recently revealed in the case of United States v. Chhibber, reviewed by the U.S. Court of Appeals for the Seventh Circuit.
In this case, the doctor was convicted of four counts of making false statements relating to health care matters and four counts of health care fraud, both violations of federal law. He appealed his conviction, but the appellate court confirmed.
Specifically, what this doctor did was operate a walk-in medical clinic outside of Chicago. He caught the eye of federal authorities after a pattern was revealed in which patients insured by Medicare received an “unusually large volume of diagnostic tests,” including echocardiograms, electrocardiograms, pulmonary function tests, nerve conduction studies, carotid Doppler ultrasound scans and abdominal ultrasound scans.
The doctor was convicted of obtaining reimbursements for those tests by presenting claims that contained misleading or false diagnostic codes, and also recording “fake symptoms and sham diagnoses” in the medical charts of his patients.
Despite the fact that these tests were complex, he never provided any formal training to his staff on how to conduct them. Staffers say “training” consisted of a five-minute review. Once the tests were returned, staffers would later testify, the results were never reviewed.
Undercover officers would later pose as patients and learn that the symptoms they reported were never recorded in their charts, and the results of their tests and/or the “serious medical condition” that necessitated those tests were never discussed with them.
This presents several problems. Even if the tests weren’t ordered on the basis of actual identified condition, such a low standard of care would put a patient at risk of having a potentially serious medical problem overlooked.
Additionally, such diagnostics and tests can be invasive and are accompanied with their own risks.
In order to have a strong basis for a liability claim, your attorney would need to show that not only was the doctor or health care provider negligent in providing you care, but that you suffered some quantifiable injury as a result of that negligence.
If your doctor or health care provider has been investigated or arrested for Medicare fraud and you suffered an injury, yo may have grounds for a medical liability claim.
Contact our North Carolina personal injury lawyers at Lee Law Offices today by calling 800-887-1965.
United States v. Chhibber, Feb. 3, 2014, U.S. Court of Appeals for the Seventh Circuit
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