Healthcare and business are two things that go hand in hand. Although, it’s only positive until the business becomes a mask for personal gain. Even though it may appear that funding is going to the patients and helping them, in many cases it’s being misused. Doctors are submitting fake claims to Medicaid or Medicare, which cover the costs for the patients needs. It’s true, many healthcare officials and providers are using government funding for their personal gain. Money coming from Medicaid and Medicare is going directly to the provider and not the patient. The patients are being mistreated and receiving low quality treatment.
In the time span between 2016 and 2022, two doctors in Dallas made healthcare claims for injections containing narcotics. The patients went to the clinic for 15 minutes each time, only to believe that they received injections. Instead, the doctors brought needles near the skin without actually piercing it. In some cases, the patient received treatment but in very low quantities.
After providing this meager amount of treatment, the doctors allegedly claimed that the patient received 80 injections in one visit. Evidence from court shows how they billed almost $4000 for one patient in a single day. Eventually, this fraud gained attention from higher authorities when a woman died of drug overdose. The doctor involved was accused of improperly prescribing controlled substances. As a consequence, he had to be monitored by another physician. After numerous allegations he was finally caught with evidence of violating the law. This resulted in him being arrested.
If the doctors are convicted, they would face up to 20 years in prison and a penalty of $12 million. The Stark Law (self referral law) and the FCA (False Claims Act) which is categorized under the Social Security Act in section 1877 are both violated. This is a serious offense which may have further consequences affecting the doctor’s future. With such significant consequences it isn’t worth scamming the patients and receiving money from Medicaid or Medicare. If society doesn’t gain awareness of scams like this, people will continue to be victims of healthcare frauds.
Citations:
Maddox, W. (2023, December 20). Two Dallas physicians charged in $12 million fraud scheme. D Magazine. https://www.dmagazine.com/healthcare-business/2023/11/two-dallas-physicians-charged-in-12-million-fraud-scheme/
The False Claims Act. (2023, April 4). https://www.justice.gov/civil/false-claims-act