I Was Sued for Medicare Fraud-Over an Innocent Error
Keskinen, Rosemary S., Medical Economics
Unfairly charged as a swindler by a former patient, the author was forced to fight a tortuous and costly legal battle to clear her name.
Like most doctors, I've always lived in dread of a malpractice suit. But, I discovered, being charged with Medicare fraud and abuse can be even worse.
These charges challenge our integrity-accusing us of cheating not only the system but our own patients.
If you've been accused of fraud, as I was, you don't talk about it for a long time. My suit made me miserable for the better part of a year, and it cost me nearly $10,000. I didn't deserve to be put in the position I was, but it happened anyway. That's why I've decided to break my silence: If this could happen to me, it could happen to anyone.
A name from the past sets events in motion
My nightmare began on a May morning in 1995. I'd been asked by one of my partners to come to the office early. The request hadn't alarmed me, since I was often asked to confer on issues involving my small satellite office. (I'd sold my two-doctor practice to a larger dermatology group the year before.)
As I walked into the meeting, I noticed the group's two senior partners and the practice administrator. They weren't smiling.
"Does the name Stanley Szabo mean anything to you?" one of the partners asked me.
It did. Szabo-not his real name-was an elderly diabetic widower who'd come to me with familiar geriatric complaintspruritus, leg ulcers, stasis dermatitis. I followed him for many months, until he was admitted to a nursing home some distance from my office. Although he could be cranky at times, we'd parted on good terms about a year before. I hadn't seen him since.
Szabo and his attorney, the partner informed me, had brought a Medicare fraud suit against me on behalf of the US government. I'd been accused of billing for services that were either disallowed or never provided. I was also accused of trying to recover additional payments for services that were already reimbursed.
Even though the alleged fraud took place before I had sold my practice, my new dermatology group had been named in the lawsuit. That explained my partners' grim mood. I could do nothing to allay their concerns, since I was as much in the dark as they were. Stunned, I asked myself why Szabo would want to sue me.
His stasis ulcers had required weekly and sometimes twiceweekly Unna boot changes. But his diabetes-related blindness meant he couldn't drive, and, apparently, no family members were around to help. That left him dependent on our community transportation vehicle to get to the office. When that wasn't available, members of his church would drive him. In time, we also arranged weekly nurse visits.
More than a few times, however, all systems failed, and I made house calls to soak his leg and change his boot. On such visits, he wasn't eager to let me depart. Living alone, he was so obviously in need of companionship and sympathy that I often ended up staying longer than I'd intended. Truly, I had gone the extra mile for this patient, which made his complaint against me all the more difficult to understand.
Accusations of a pattern of fraud
Returning to my office later that May morning, I noticed a large envelope-sent by registered mail-bearing an attorney's name and address.
Inside was a copy of the complaint filed against me in US District Court by my former patient, "in the name of the United States Government." It accused me of billing for an ultraviolet-light treatment I'd never provided, and of "balance billing" for charges not covered by Medicare.
Worse, the complaint described these incidents as part of a larger pattern of fraud and abuse. Allegedly, this pattern involved not only the plaintiff but other Medicare beneficiaries, as well.
I was stunned. Medicaremuch less Szabo-had never told me any of this. If the court found against me, the complaint said, I'd have to pay a judgment equal to three times the alleged damages the government had sustained, plus a civil penalty of $5,000 to $10,000 per violation. …