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CASE STUDY: ACTING FOR THE DEFENSE
Accused Of Fraud, A Good Doctor
Is Rescued In Court
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An elderly primary care physician, now retired, was well-known for his tireless dedication to his patients, often managing more than 100 visits per day - in his office, in hospitals and in nursing homes. He was held in high regard by his colleagues, who described him as a "human machine." His was an old-school practice, and visits were tracked using a little book with concise, often incomplete, handwritten notes. Putting patients first meant never getting bogged down with the paperwork or technology demanded by modern record-keeping standards.
No good deed goes unpunished.
Previously sanctioned by Medicare for documentation and coding violations, he hadn't "mended his ways," and his high visit volume and thin records eventually drew red flags, resulting in an investigation. The FBI raided his home, office and the homes of his staff. Criminal charges of scheming to submit fraudulent claims to Medicare and Medicaid followed, bringing the prospect of imprisonment and financial penalties of $10.7 million sought by the FBI, the Department of Justice, the Office of Inspector General and the State's Attorney.
VantagePoint joins the defense...
Tapped by his attorneys to provide technical and medical support, VantagePoint reviewed records and conducted extensive interviews with patients, colleagues and nurses to substantiate the fact that the doctor was rendering care, not committing fraud. Significantly, the charges themselves were critically assessed for validity in the context of Medicare guidelines, and it emerged that the prosecution had improperly based their audit methodology on a 20-minute per patient visit model. Therefore, their assertion - that the doctor's high volume of patient contacts was implausible and therefore fraudulent - was fundamentally invalid.
...and wins the day.
With these flaws revealed in the prosecution's case, all criminal fraud charges were dropped, leaving only civil charges stemming from billing and compliance irregularities. The threat of imprisonment was eliminated, and financial penalties were reduced by more than 75%. The period of exclusion from Medicare/Medicaid participation was reduced by half, and lenient terms for the payment of his penalty were negotiated.
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THE VANTAGEPOINT ADVANTAGE
Our keen expertise in the world of regulatory compliance serves many of our clients in the cause of prevention, and is sometimes tapped by client legal counsel as essential to a cure.
VantagePoint is a team of industry experts who are dedicated to improving the business of medicine. With vast experience in executive management, operations, finance, clinical services and compliance, we deliver unparalleled, measurable and quantifiable results for our clients.
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