Dermatologist Fraud and Abuse Risks – Identified from Florida Case Targeting Demotologist

An allegation from a competing dermatologist resulted in a Federal government investigation of a Florida dermatologist.  The dermatologist was accused of charging the Medicare program for unnecessary biopsies and radiation treatments that were not rendered, not properly supervised, or given by unqualified physician assistants.  It was alleged the doctor was not even in the country when some of the procedures at issue were performed.  The unnecessary charges were alleged to have totaled around $49 million over a 6-year period.

The dermatologist did not admit wrongdoing in the settlement.  Rather, he alleged the overbilling resulted from his unique practice that relied on radiation, instead of disfiguring surgery, to help patients.  The doctor claimed he had cured “over 45,000 non-melanoma skin cancers with radiation therapy” over a 30-year period.  The problem with that argument appears to be the fact that the dermatologist was not trained or qualified in providing radiation oncology treatments.

There are a number of interesting things about this case.  The case was brought by a competing physician as a whistleblower.  The physician who brought the case expressed concern about having to treat patients that the accused doctor had misdiagnosed with squamous cell carcinoma.

The case also alleged significant billing for services allegedly provided when the doctor was not even in the office.  The accused doctor alleged he was available by phone while the procedures at issue were being performed.  This raises interesting issues under the rules regarding “incident to” billing.  Those rules permit a physician to bill for physician extender services.  In order to qualify to bill a service as “incident to” a physician’s service, the billing physician must meet supervisions requirements.  The physician must be physically present within the office suite during the performance of the procedure in order to qualify to bill a service as “incident to” the physician’s services.

It appears there were a number of things going on in this case.

• There appears to have been a pattern of diagnosing a higher level of severity than was supported by the patient’s condition.
• There was a routine use of radiation therapy, even in cases that were not medically appropriate.  This placed patients at potential risk.
• There appears to have been questions whether the accused doctor was authorized to perform radiation therapy.
• There were issues regarding improper use of the “incident to” billing rules when the doctor was not present to actively supervise the service.
• There was also some evidence the doctor had offered incentives for staff to misdiagnose and over utilize the radiation treatment.
• There was an alleged kickback arrangement with another physician who operated a clinical laboratory.

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Source: Health Law Blog