This week our commentary on our favorite articles. We are excited to see that the issues we know are important are becoming more mainstream.
A Florida chiropractor signed hundreds of mask exemption forms for students. Now, the district has tightened its mask policy (CNN)
Without the political hyperbole, does a chiro signing off on mask exemptions go beyond scope of licensure? Did this provider just get a spotlight on him? Were the consults leading to his signing the forms needed for an exemption submitted to insurers for payment as an E/M? I think this will open a can of worms for this guy. My advice would be to stick to adjusting subluxations of the spine.
Man Pleads Guilty to Fraudulently Obtaining Approximately $9 Million in COVID-Relief Loans, Some of Which Was Gambled Away (justice.gov)
Although I typically comment on healthcare fraud matters only, since is tangentially related (CARES ACT) it seems appropriate. The sad part is that nearly all of the money is gone and will never be recovered. As with healthcare fraud matters, the amount that is recovered typically does not reflect the true fraud identified. As the PRAC gains momentum, I am sure we will see more of these prosecutions. Agency data will be shared and mined, and additional targets identified where the application for a loan was not consistent with other datasets. There is already some momentum with healthcare fraud and loan fraud schemes, as was the case with the recent plea of Dr. Ameet Goyal. As with many fraud schemes, we may never gain a full understanding of the depth and breadth of the losses incurred.
El Paso Businesswoman Arrested for Health Care Fraud (justice.gov)
The Strike Force operates nationally. Agents in various OIG offices are regionally assigned to be the lead agents on healthcare fraud matters. Many in the general public hear OIG and do not understand that there are many components to what makes up the OIG.
Agents from the OIG are part of the Office of Investigations (OI), and have nearly the same training as every other federal law enforcement agency. OI agents are the law enforcement organization that is primarily responsible for the criminal, civil and administrative investigations that involve federal healthcare programs. Although commonly confused with other agencies, the OI is not the FBI, not part of the FBI, and is its own federal law enforcement agency. OI agents have the same job series, retirement and benefits afforded to agents from the traditional agencies (such as the FBI, DEA, ATF, etc.).
When committing healthcare fraud, it is a bit like your grandmother’s meatball recipe: a bit of this, a pinch of that. In the case below, I had a hard time finding something that was not on the usual hit list of fraud. The creation of false medical records, kickbacks, forging signatures, are all hallmarks of the roadmap of fraud. The hospice cases really get me, as that is an actual level of care that people who are dying need, and when we read about these prosecutions, it soils the name of what is otherwise a valuable part of the end of life cycle.
By Eric Rubenstein & Jeanmarie Loria