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NY psychiatrist faces 10 years prison sentence for health care fraud

The United States Attorney for the Western District of New York has charged a local psychiatrist with health care fraud. The medical professional operates a private practice, has served with many nursing homes and has also spoken at consulting engagements for pharmaceutical companies.

What did the doctor do wrong? The government has accused the doctor of deceptive practices that rise to the level of health care fraud. The actions under review include his practice from July of 2012 through June of 2018.

The allegations include:

  • False billing practices. Accusations include falsely billing telephone consultations as in office visits. The government also gathered video surveillance evidence to support charges that he falsely reported the time he spent with patients. The evidence allegedly shows the exact times the physician entered and exited his practice to conduct his work day. The government then aligns these recordings with reported hours spent with patients to establish improper reporting.
  • Inadequate records. The government has also accused the physician of over billing for evaluation and management (E/M) services provided to new patients. The prosecution states the physician does not have adequate documentation within patient records to support the E/M services charged.

If the government is successful in its prosecution of the physician, he could face up to ten years imprisonment and a monetary fine of $250,000.

What can other doctors learn from this case? Medical professionals in similar situations have options. Defenses to government allegations of fraudulent billing practices are available. An attorney experienced in these matters can review the details of the allegations and help to tailor a defense strategy to your unique case, better ensuring your legal rights are protected.

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