Pain Doctor Charged in $32.7M Medicare Fraud Scheme

[TheLoneWolf]

Billed Medicare nearly 33 million over 13 years for urine drug testing. I'm so surprised he actually thought he could run under the radar with these numbers.

My fellowship director told me a prior grad opened his own clinic and found out pretty quickly that he could make more with aggressive urine testing and short prescribing visits than doing fast and efficient procedures.

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[lobelsteve]

Link please

 

[buddababa]

Link please

Doctor Charged in $32.7M Medicare Fraud Scheme

A federal grand jury in Lafayette, Louisiana, returned an indictment today charging a Louisiana doctor for his role in a scheme to defraud Medicare of over $32.7 million by submitting claims for medically unnecessary definitive urine drug testing services.

www.justice.gov

 

[buddababa]

"Everyone in Alexandria’s medical community has suspected for years that he’s defrauding Medicare. He’s known for overprescribing pain meds (Morphine for everyone!) and abusing urine drug screens, and firing patients for any reason and no reason at all, but always citing ‘noncompliance’. I’d often wondered how he got by with billing them because Medicare is so strict about UDS that our clinic won’t even prescribe pain meds anymore.

Gonna be some pissed off addicts in Alexandria though - he’s the only medication based pain management prescriber left in the area."

--comment online

 

[Gnarvin]

Are there actually guidelines about maximum frequency of UDS? Is monthly too frequent? I tried finding this type of guideline but didn’t see anything definite.

Is it fraud to get confirmatory testing on every UDS if your clinic owns the screening lab and the owner (but not you) owns the confirmatory lab and makes you send it to that lab?

Medicare should have an LCD specifically for UDS that goes over the accepted frequency in detail and when they think confirmatory is appropriate. You might want to read it very carefully given the scenario you mentioned.

 

[sloh]

"Everyone in Alexandria’s medical community has suspected for years that he’s defrauding Medicare. He’s known for overprescribing pain meds (Morphine for everyone!) and abusing urine drug screens, and firing patients for any reason and no reason at all, but always citing ‘noncompliance’. I’d often wondered how he got by with billing them because Medicare is so strict about UDS that our clinic won’t even prescribe pain meds anymore.

Gonna be some pissed off addicts in Alexandria though - he’s the only medication based pain management prescriber left in the area."

--comment online

Where did you find the comments?

 

[TheLoneWolf]

"Everyone in Alexandria’s medical community has suspected for years that he’s defrauding Medicare. He’s known for overprescribing pain meds (Morphine for everyone!) and abusing urine drug screens, and firing patients for any reason and no reason at all, but always citing ‘noncompliance’. I’d often wondered how he got by with billing them because Medicare is so strict about UDS that our clinic won’t even prescribe pain meds anymore.

Gonna be some pissed off addicts in Alexandria though - he’s the only medication based pain management prescriber left in the area."

--comment online

Who will now take in the opioid refugees? Won't somebody think of them

 

[TrailRun]

How much does a UDS even pay? If labs are that profitable then I must have made the hospital millions when I worked ER

 

[BobBarker]

UDS confirmations used to pay like $2400. This ended around 2015.

 

[BobBarker]

We had a large lab here that also owned a pain clinic that was pumping out prescriptions in order to justify more UDS

 

[Laryngospasm]

Lot of people got rich off f this scheme back in the day. Was super common in Louisiana and probably everywhere else. You can imagine the numbers seeing 30-50 patients a day and testing them all. It was practically a money tree.

 

[Status Sciaticus]

UDS confirmations used to pay like $2400. This ended around 2015.

How much are you getting for screenings?

 

[BobBarker]

Maybe $12

 

[gaspasser127]

Maybe $12

How much do confirmations pay now?

 

[swamprat]

How much do confirmations pay now?

We had an LCMS - the best payor outside of WC (paid like $800), was an obamacare plan that paid likw $240. Medicare paid like $250.

 

[BobBarker]

Medicare pays the outside lab around $240

 

[lioneljohn]

That should serve him right. If anyone else wants to do it, here's a link to help you: https://federal-lawyer.com/whistleblower-lawyers/report-medicare-fraud/