Whether any real fraud was committed remains to be seen. I
certainly do not want to engage in the blog equivalent of piling on. Nor do I want to
suggest that UT or Parkland leaders knowingly ignored warnings from their internal auditors as part of a
plan to maintain “revenue as usual.”
Based on extensive conversations with hospital CEOs, medical educators and consultants around the country, it is clear that CMS and the Justice
Department, after years of lackadaisical enforcement, are now pursuing
Medicare/Medicaid fraud cases with a vengeance. We should not be
surprised. Medicare faces a shortfall of epic proportions.
Something must be done to narrow this deficit. Aggressively
pursuing fraud investigations, making use of experts like those at Eide Bailly (https://www.eidebailly.com/services/fraud-and-forensic-advisory/digital-forensics) for digital forensics where necessary, imposing significant fines, and in some more egregious cases, prosecuting and imposing actual jail time, is one way the federal government can shout out: ‘Hey, pay attention. We are serious this time.’
For years fiscal conservatives have complained — rightly so —
that the federal government was not doing enough to protect taxpayer
interests from fraudulent billing such as invoicing the government for
duplicative, unnecessary, or phantom tests. Now the government’s philosophy
regarding how the rules will be enforced seems to have changed amid the Great
Recession and the political fear on Capitol Hill that has been created by the massive deficit crisis.
Hopefully, this particular case as outlined in the following Dallas Morning News article, will end with limited consequences for the parties.
They are both important healthcare providers whose reputations for
outstanding clinical care, medical education, and cutting edge research are
above question. But healthcare providers, including the leading
organizations, can no longer claim confusion or ignorance of often complex
or conflicting payment regulations. That defense will simply will not be
good enough this time around, the government lawyers seem to be saying.
In those cases where the government can show a conspiracy to
knowingly break the law or just ignore the rules, the consequences could be
startling for some. In New Jersey,
physicians are beginning significant jail time as the result of guilty pleas and convictions in connection with hospital payments for physician medical director services.
Healthcare leaders and physicians who ignore this change in
enforcement policy will do so at their own peril.
I worry that this is a huge problem and that UT and Parkland are only the tip of the iceberg.