On Feb. 10, a New Jersey doctor was charged for billing Medicare and Medicaid for tests that were not actually performed. According to the complaint, the gynecologist allegedly billed both agencies for rectal tests between 2006 and 2011, none of which were conducted.
The complaint also stated the doctor billed more than the next top 10 billers in the state. The prosecutors in the case interviewed numerous patients, all of which claimed that they had not had the procedure done. Further, the doctor allegedly billed the agencies numerous times for individual patients. Because the test is diagnostic and not therapeutic, the agencies should have only been charged once. Further, prosecutors claimed that Medicaid and Medicare were billed while he was traveling out of the country in 2008 and 2009.
The doctor's attorney stated that he stopped billing for those specific procedures as soon as he became aware that there was a problem. Additionally, the attorney stated that his client had offered to repay the total cost of the billings for those particular procedures. However, the complaint was seeking three times the amount of damages that the agencies sustained. Negotiations were still being made.
People who are accused of fraud may face serious legal consequences upon conviction that could include incarceration as well as fines. They could also potentially lose their job and have trouble seeking future employment. An attorney can determine an appropriate defense strategy depending upon the particular facts and circumstances, including asserting that the defendant lacked the specific intent to defraud that is a required element of the crime.
Source: NJ.com, "N.J. doctor charged with fraudulently billing for tests", Tim Darragh, Feb. 10, 2016