Case Result: Rheumatology Practice Discharged of Alleged Medicare Incident to Violations

Professional:
Regulated Facilities
Doctor

Primary Issue:

The Department of Justice (“DOJ”) believed that a successful Arthritis and Rheumatology practice (“the practice”) in New Jersey was in violation of Medicare incident to guidelines while our client, a dedicated Rheumatologist, was out of the country. There was also concern about services being rendered in an adjacent infusion clinic, and whether or not there was appropriate coverage for this clinic.

The practice then received a Grand Jury subpoena for medical records, patient charts, billing records, and audit trails pertaining to six selected patients.

Without hesitation, our client retained Chapman Law Group’s White Collar Defense team on behalf of himself and the practice to assist in tackling the DOJ’s subpoena request.

Argument:
White Collar Defense Practice Chair Ronald W. Chapman, II, LL.M. and the White Collar team wasted no time. They began by contacting Michael Staples, CMBI to perform an internal investigation of the practice.

Investigator Staples traveled to the practice, where he interviewed staff and patients, reviewed medical and business records, and inspected the facility. His findings concluded that the Rheumatologist and his practices “exhibit zero indications, intent, or evidence of being involved in a scheme to defraud private or government healthcare insurance.”

Additional investigation by the White Collar team found that there was a flaw in the practice’s Electronic Medical Record (“EMR”) system. This issue did not allow the performing provider to be accurately identified in the patent’s chart, resulting in our client to be listed as the performing provider for all established patients.

In terms of the adjacent clinic, the team was able to present to the DOJ that the infusion clinic had recently moved out of our client’s physical office space. We advised that our team, with the help of Doctors’ Management, were taking appropriate steps to remedy potential issues. Doctors’ Management was hired separately to assist in maintaining compliance for the practice.

Results:
Upon presenting Investigator Staples’ findings, the EMR system’s flaw, and the preventative measures taken in response to the neighboring infusion clinic to the DOJ, the decision was made to close the Fraud Sections investigation. The DOJ decided that no further action was to be taken against our client or his practice by the U.S. Attorney’s office in regards to the Medicare incident to violation allegations.

Area of Law:
Grand Jury Investigation
Medicare Fraud Defense

Attorneys:
Ronald W. Chapman, II, LL.M.

Disclaimer: This information is a sample of our past results. Prospective clients may not obtain the same or similar results. Every case is different and each case must be evaluated and handled on its own merits. The circumstances of your case may differ from the results provided. The information provided has not been reviewed or approved by the State Bar.