Lack of Doctor Supervision

Atlanta Medicare/Medicaid Fraud Attorney

When a doctor is supposed to be supervising health care — but isn’t — patients are being put at risk and Medicare and Medicaid are paying for physician supervision that patients are not getting. By filing a False Claims Act lawsuit, you can stop the fraud and help patients. You also will be entitled to get between 15% and 30% of the amount the Government recovers.

Discuss filing a whistleblower False Claims Act lawsuit about a lack of physician supervision with an Atlanta Medicare fraud lawyer at The Wallace Law Firm, LLC. Lee Wallace at our firm has been named one of Georgia’s Super Lawyers®, Top 100 Lawyers, Top 50 Women Lawyers, and Top 100 Trial Lawyers. She has handled legal matters in 20 states.

Get started with your FREE whistleblower consultation today.

How Hospitals & Doctors Cheat the System

Increasingly physician practices, hospices, hospitals, and other medical facilities are turning to non-doctors to provide patient services. The system can be a win-win: when non-physicians are appropriately supervised, Medicare, Medicaid and insurance companies can save money by not having to hire doctors — who are more expensive. But the system goes awry when no doctor is actually providing the supervision.

Heathcare providers can defraud Medicare and Medicaid in several different ways when a doctor is not supervising patient treatments:

  • First, a medical provider (such as a nursing home, home health company, rehab or regular hospital, or skilled nursing facility) may know that Medicare will not reimburse certain procedures unless they are supervised by a doctor, and yet the institution may simply fail to bring in a doctor to supervise the patients’ medical care at all. These healthcare providers are beefing up their profits at the expense of their patients. The Centers for Medicare and Medicaid Services (CMS) required doctor supervision for a reason, and in these situations the risk to the patient is obvious. The institution bears the fault, since it failed to hire a doctor to provide the supervision.
  • Second, the doctor may be involved in or even in charge of the scam. He knows he should be supervising the people working under him, but he chooses not to. In some extreme — and unfortunately real — situations, a doctor has claimed to be supervising patient treatments when in fact he was not even in the country, much less the office, when the patient received the medical services. In this type of fraud, the doctor is clearly at fault. If he works for or with an institution, the institution may also be responsible for the failure to supervise the non-physicians who are delivering the healthcare treatments.
  • Third, the fraud can happen via “upcoding.” Medicare has rate scales that show how much it will pay for a doctor to perform a procedure (the maximum amount), for a non-physician to perform the same procedure while under a physician’s supervision (a lesser amount), and for a non-physician to perform the procedure with no doctor’s supervision (the least amount, or for some procedures, no payment at all). A hospital, hospice, physician’s practice, doctor, etc., may “upcode” the procedure, selecting the code that tells Medicare that a doctor performed the procedure himself when he really only supervised it, or telling Medicare that the doctor supervised the procedure when he did not.

U.S. Taxpayers Cannot Afford to Foot the Bill For Healthcare Fraud

If you know of a hospital, physician or other healthcare provider that is billing Medicare and Medicaid when a doctor is not properly supervising the treatment of his patients, or that is upcoding to suggest more supervision than is really being given, email The Wallace Law Firm, L.L.C., today, for a free consultation about how you can be a whistleblower who helps the Government end lack-of-supervision fraud. When the Government recovers, so do you; you can receive 15% to 30% of what the Government collects because you told them about the fraud.

First in her class at Vanderbilt University, Lee Wallace graduated with honors from Harvard Law School. She devotes her practice to representing individuals like you who are sick of watching healthcare providers take U.S. taxpayers to the cleaners.

You can make a difference. Learn more by contacting us at (404) 550-4615.