Recently, the University of Pennsylvania Health System, commonly known as Penn Medicine, agreed to settle allegations regarding fraudulent claims for fetal ultrasounds. The Justice Department claims that because the Maternal Fetal Medicine division at Pennsylvania’s Lancaster General Hospital (LGH-MFM) was understaffed, ultrasound reports for high-risk pregnancies went as long as 30 days to three months without being completed.
These delays presented an obvious risk to mothers and babies. Significant delays in interpreting ultrasound results render them essentially useless, compromising patient care. In some cases, reports came in after the baby was born. This backlog also created a system where reports were submitted to Medicaid, even though they were overdue and ineligible for reimbursement. The government calls this a violation of the False Claims Act (FCA).
It was concerned patients who first tipped the government off to the problem of delayed ultrasound reporting. From there, the United States Department of Health and Human Services Office of the Inspector General began investigating. Penn Medicine Trustees agreed to settle the case on behalf of LGH-MGM for $275,000.
Physicians and False Claim Allegations
Billing fraud is undoubtedly a growing problem in the health care industry. Penalties for violating the FCA are severe. In 2018, the government collected $2.8 billion in damages from government contractors. While the FCA is an important form of protection for patients and consumers, it can also be used to penalize physicians falsely accused of fraud.
Even the most ethical health care provider is likely subject to insurance company scrutiny at some point. Insurance companies want a reason not to pay physicians and are always looking for possible signs of fraud. Red flags can be billing under a specific code more frequently than other local physicians or billing for a procedure or test the insurer considers unnecessary.
Because physicians have so much to lose, they cannot afford to fight allegations of false claims and health care fraud without the representation of a knowledgeable physician lawyer experienced in handling similar cases. Doctors choosing to dispute insurance company decisions need to follow the guidelines strictly outlined in their contract. A lawyer experienced in advocating for physicians ensures proper procedures are followed to give the health care providers the opportunity for a positive resolution.
Philadelphia Physician Lawyers at Sidney L. Gold & Associates, P.C. Advocate for Health Care Professionals Facing Billing Violations
If you are a health care provider in need of legal assistance, contact a skilled Philadelphia physician lawyer at Sidney L. Gold & Associates, P.C. today. Call us at 215-569-1999 or complete the convenient online contact form to schedule a free consultation today. Located in Philadelphia, we serve clients throughout Bucks County, Chester County, Delaware County, Montgomery County, Wilkes-Barre, and Scranton.