Category Archives: Healthcare Fraud
Florida Statute 458.331: Understanding Grounds For Physician Disciplinary Action
The practice of medicine carries immense responsibility, and physicians are held to high ethical and professional standards. In Florida, medical professionals must comply with strict regulations under Florida Statute 458.331, which outlines the grounds for disciplinary action against physicians. Violations can lead to severe consequences, including suspension or revocation of a medical license. Understanding… Read More »
How Social Media Can Affect Your Medical License: Ethical And Legal Considerations
Social media has become an essential part of everyday life, allowing professionals, including doctors, to connect with colleagues, patients, and the public. However, for medical professionals, the use of platforms like Facebook, Instagram, Twitter (X), TikTok, and LinkedIn can present serious legal and ethical risks. A single post, comment, or even a private message… Read More »
Unbundling And The Anti-Kickback Statute: Are You At Risk Of Violations?
Understanding Unbundling in Medical Billing Unbundling refers to the practice of separately billing for procedures that should be covered under a single comprehensive code. This practice increases reimbursement by breaking down services into individual components rather than charging a single, inclusive rate. While unbundling can sometimes be the result of legitimate coding errors, it… Read More »
Upcoding Vs. Billing Errors: When Does A Mistake Become A Crime?
Medical billing is a complex process that requires precision, compliance with federal and state regulations, and adherence to ethical standards. While billing mistakes can occur due to clerical errors or coding misunderstandings, upcoding—the act of billing for more expensive services or procedures than what was actually performed—can lead to criminal charges and severe penalties…. Read More »
The Role Of Due Process In Medical License Defense: What Physicians Need To Know
For physicians, maintaining a valid medical license is essential to practicing medicine. However, allegations of misconduct, malpractice, or regulatory violations can place a doctor’s career in jeopardy. When a physician’s license is at risk, due process plays a crucial role in ensuring a fair and just legal proceeding. Understanding the legal protections afforded to… Read More »
A Look At Recent Settlements In Healthcare Fraud Kickback Schemes
Healthcare fraud remains a significant concern in the U.S., as demonstrated by recent settlements involving seven individuals and entities accused of violating the Anti-Kickback Statute and the False Claims Act. The Justice Department announced that these parties, including laboratory marketers, physicians, and a medical practice owner, agreed to pay over $1.1 million to resolve… Read More »
Kickbacks And Fraud: The Case Of Medically Unnecessary Brain Scans
A legal development occurred in a healthcare fraud case involving a New York operations manager, Timothy Doyle, who pleaded guilty to conspiracy charges. The case highlights how kickbacks in healthcare, particularly those involving diagnostic testing, undermine the integrity of federally funded programs like Medicare. The Scheme: Fraudulent Brain Scan Orders From 2013 to 2020,… Read More »
Insurance Fraud: False Claims And Exaggerated Medical Services
Insurance fraud is a serious crime that involves submitting false or misleading information to insurance companies for financial gain. It spans across various types of insurance, including health, auto, and property coverage, costing insurers—and ultimately policyholders—billions of dollars annually. One of the most common forms of insurance fraud involves billing for services not provided… Read More »
Texas Doctor Sentenced To Over 10 Years For Medicare Fraud Scheme
The recent sentencing of Dr. Daniel R. Canchola, a Texas physician, highlights the severe consequences of participating in fraudulent schemes targeting federal health programs. Sentenced to 10 years and one month in prison and ordered to pay over $34 million in restitution, Dr. Canchola’s case illustrates the seriousness of Medicare fraud and the government’s… Read More »
Physician Self-Referral Law: Navigating Section 1877 Of The Social Security Act
Physicians who refer patients for designated health services (DHS) under Medicare to entities they have a financial relationship with may be in violation of Section 1877 of the Social Security Act, also known as the physician self-referral law or the Stark Law. This law prohibits such referrals unless specific exceptions apply. Violations can result… Read More »
