tci Medicare Compliance & Reimbursement - 2019 Issue 3
Fraud And Abuse: Physician Fraudsters Are On Feds’ Target List
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Article Overview
This article reviews a set of recent U.S. Department of Justice enforcement actions involving physicians accused of fraud, false billing, medically unnecessary services, home health documentation issues, and illegal controlled-substance prescribing. It is aimed at readers who follow Medicare compliance, health care fraud enforcement, and pharmacy/controlled-substance oversight. The piece emphasizes the types of conduct under investigation, the agencies involved, and the broader enforcement focus without providing step-by-step coding guidance.
Why This Topic Matters
It helps compliance and revenue integrity readers understand the kinds of enforcement priorities being emphasized in physician fraud cases and why documentation, billing, and prescribing practices are under scrutiny.
Article Sections
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Texas home health fraud cases
Summarizes two separate enforcement actions in Houston involving alleged home health fraud and related Medicare issues. The section focuses on the general nature of the conduct and the resulting penalties.
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Florida false billing and opioid prescribing case
Covers a Florida case involving false billing, medical record issues, and controlled-substance prescribing concerns. The section also notes federal program exclusion and criminal sentencing.
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Georgia controlled-substance prescribing case
Describes a Georgia enforcement action involving alleged improper prescribing activity across multiple locations and states. The section highlights the federal response and the broader opioid-enforcement context.
What You Will Learn
- The general categories of physician fraud and abuse described in recent federal enforcement actions.
- How federal agencies are framing home health, billing, and prescribing investigations.
- Which specialties and practice settings are implicated in the article's enforcement examples.
- Why documentation and claims integrity are central themes in health care fraud enforcement.
Who Should Read This
- Medical coders
- Compliance professionals
- Revenue integrity staff
- Health care attorneys
- Physician practice administrators
- Auditors
- Fraud and abuse investigators
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