In the latest show of force against health care fraud, a Maryland cardiologist agreed to pay the federal government $476,000 in a settlement to drop claims that he bilked Medicare out of hundreds of thousands of dollars.
Dr. Pradeep Srivastava was accused by the U.S. Department of Justice with violating the False Claims Act by billing for services not rendered; “unbundling,” or billing for each separate component of a procedure; and “upcoding,” or charging for a higher service than the one provided.
Srivastava has denied the claims.
Still, Srivastava, along with his corporate entity, agreed to a settlement that included entering into a five-year integrity agreement with the Office of the Inspector General of the Department of Health and Human Services. The 34-page integrity agreement with DHHS imposes compliance measures and ongoing monitoring to ensure the veracity of Srivastava’s future federal health care claims.
“These things have become fairly common, especially with cardiologists,” said Colorado Springs attorney Keith Cross, who specializes in medical malpractice and fraud whistle blowing cases.
Cross said he doesn’t know of any local doctors or surgeons who have been required to enter an integrity agreement, but, that doesn’t mean there aren’t any ongoing investigations which are under seal.
Lisa Rockelli, managing editor for the BNA’s health care policy report, which tracks fraud reports nationally, said she has an idea why cardiology fraud cases might be so prominent.
“There are just so many billing steps along the way,” she said. “There are hundreds of ways to potentially create false billing or to double bill.”
Srivastava was accused of charging for a combined left- and right-heart catheterization but only performing the left, and for double billing for pacemaker insertion from November 1999 through May 2003.
Federal prosecutors likened the alleged scheme to buying a hot dog from a stand and being charged extra for the bun, for each condiment and a service fee for assembling the food.
Srivastava’s attorney, David O’Brien, said the matter arose because of billing code confusion and that Srivastava settled because the federal government’s power to take away Medicaid business.
“The government has a very, very powerful lever,” he said. “They can threaten to exclude any doctor from participation in federal health care programs. The risk is extremely grave. So in return for not proceeding with the exclusion, the doctor had to pay the money in the settlement and enter into an integrity agreement.”
To see a list of medical companies that have been accused of fraud and were required to enter into a corporate integrity agreement, visit www.oig.hhs.gov and search under the “Fraud Prevention and Protection” tab.
Think you’re one hot health care case manager?
You can prove it by entering an American Case Management Association and The Joint Commission contest that seeks to recognize those who strut the industries best practices.
The deadline to enter the Franklin Award of Distinction is Nov. 30. Visit www.amcaweb.org to enter.
The award is named for Benjamin Franklin, who was co-founder of the first organized hospital in the United States.
The hospital or health organization that wins will be recognized during a formal national ceremony. How’s that for well-deserved good publicity?
Most businesses are grappling these days to find a way to pay retired employee’s health care costs, so it might be comforting to know that nation’s biggest corporations have the same problem.
General Motors and Ford Motor Co. have announced that they’re seeking to use their stock as at least part of the way to fund a multi-billion dollar union-controlled fund to pay retirees’ future health care costs.
The Detroit News reported that the automakers are seeking to shift tens of billions of future health care liabilities to union controlled funds, called a voluntary employee beneficiary association, or VEBA, similar to a $1 billion deal inked by Goodyear.
But, the automakers’ deal is likely to be much larger than that. Fitch estimates it would cost GM at least $30 billion and Ford $35 billion.
Proponents say such a deal could help the automakers become more competitive with foreign nonunion rivals without wages or benefits cuts or further plant closings.
Earthquakes, tornados, heat waves, floods, oil spills, fires, nuclear accidents, dirty bombs, pandemic flu, hurricanes, blizzards and the like can cause a lot of health care issues.
In fact The Joint Commission estimates they claim 185 deaths per day worldwide.
So, the commission says it’s a good idea to have a good plan for their aftermath.
The Joint Commission will host a preparedness conference Oct. 10-11, in Alexandria, Va. Visit www. jcrinc.com/24835/ for details.