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NY podiatrist agrees to pay $1.25M to settle FCA claim

Government officials recently accused a local New York City hospital system along with a podiatrist of fraudulent billing practices. The allegations are in connection with a whistleblower lawsuit. The whistleblower brought the claim forward in 2012, stating the hospital and the podiatrist violated the False Claims Act (FCA) when they submitted claims for expenses related to the training of podiatric residents.

Allegations include that the attending physician would bill Medicaid for services provided as if he was present for the procedure conducted by residents, even when the attending was not present. The suit also claims the director of the residency program would falsify patient records to support his claims. The resident also claimed the training facility would make fraudulent claims for graduate medical educations expenses.

The case provides an opportunity to review the various charges of misconduct a physician can face. In addition to improper billing practices, as discussed above, physicians can also face professional ramifications for allegations of the following:

  • Improper use of alcohol, drugs or medications
  • Neglecting patient care
  • Providing services not authorized by the patient
  • Ordering excessive tests or treatments
  • Failing to provide medical records upon a patient’s request
  • Failing to keep proper records

Complaints by patients, staff members or co-workers of a violation can result in an investigation by the New York Health Department’s Office of Professional Medical Conduct (OPMC). These investigations can lead to criminal charges as well as professional ramifications. The state licensing board could move forward with additional penalties, including fines and revocation of one’s medical license.

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