For 35 Texans, Wednesday was a very bad day. In the Southern District of Texas, 24 individuals were charged with fraudulent billing of almost $150 million. In the Houston area, one physician responsible for falsely billing Medicare for almost $40 million. This physician, along with his cohorts, allegedly billed Medicare for unnecessary home health services – many of which were not even delivered. Others were charged with recruiting patients for unnecessary services, many of which were also not delivered, or, in the case of durable medical equipment and supplies, were bought back from the patients and resold.
Not to be outdone, the Northern District of Texas yielded claims of almost $50 million, with 11 charged for their misdeeds. One case involved a physician allowing unlicensed persons to perform physician services, while billing Medicare for the services as if he had performed them himself. This should be a caution to Texas physicians who feel tempted to allow unlicensed personnel to perform certain services. Remember, it is not merely a question of whether or not they are capable of performing the service, it is also a matter of licensure and legal qualification.
Documents related to these Indictments and Complaints can be found here – they make for interesting reading for physicians and attorneys alike.
This wave of enforcement comes close on the heels of the Supreme Court’s ruling in Universal Health Services v. United States ex rel. Escobar, where the court made clear that the implied false certification theory can be a basis for False Claims Act liability.
It looks like it is going to be a long, hot, false claim enforcement summer.