On January 7, 2010, the United States Attorney’s Office for the Eastern District of Missouri announced that Dr. Wallace P. Berkowitz had been indicted on charges of federal healthcare fraud. The indictment alleged that Dr. Berkowitz submitted numerous claims and received payment from Medicare and Medicaid for healthcare services he did not provide at a senior services center. According to the indictment, residents of nursing homes and other residential facilities were transported to the St. Alexius Senior Services Center to receive healthcare services from various healthcare providers. The government alleges that Dr. Berkowitz made false statements when he said he spent 25 to 45 minutes examining and treating each patient when St. Alexius records document that he typically spent less than five minutes with each patient. For example, the indictment charges that Dr. Berkowitz falsely claimed he removed a foreign body from a patient’s ear under anesthesia when all he had actually done was remove impacted ear wax. Because this is a criminal case, if convicted, Dr. Berkowitz faces a maximum penalty of 10 years in prison and/or fines of up to $250,000. In addition, for each count of making a false statement with which he is charged, he faces a maximum penalty of five years in prison and/or fines of up to $250,000. http://www.justice.gov/usao/moe/press_releases/ archived_press_releases/2010_press_releases/january/berkowitz_wallace.html

This case reminds health care facilities that potential false claims problems can often be uncovered through an internal review of provider and facility records to check for consistency in the descriptions of care. Even though a valid service may have been provided, up-coding or falsely coding those services to indicate something other than the actual service rendered is a false claim, which may trigger both civil and criminal liability.