After several years of no apparent activity by the Department of Health and Human Services Office of Inspector General (“OIG”) in the area of concierge care medicine, the OIG recently settled another case involving a physician who set up a “concierge care”-type practice. The OIG recently announced on its website that it settled a case involving allegations that a North Carolina physician, Lee R. Rocamora, M.D., had violated the Civil Monetary Penalties Law (“CMPL”) when he requested payments from Medicare beneficiaries in violation of his assignment agreement. According to the OIG’s announcement, Dr. Rocamora allegedly asked his patients to enter into a membership agreement for his patient care program, under which the patients paid an annual fee. In exchange for the fee, the membership agreement specified that Dr. Rocamora would provide members with: (1) an annual comprehensive physical examination; (2) same day or next day appointments; (3) support personnel dedicated exclusively to members; (4) 24 hours-a-day and 7 days-a-week physician availability; (5) prescription facilitation; (6) coordination of referrals and expedited referrals, if medically necessary; and (7) other service amenities as determined by the physician. Dr. Rocamora agreed to pay $106,600 to resolve his liability under the CMPL.
This is only the second settlement that the OIG has announced that has involved allegations that a concierge care practice violated the CMPL. In July 2003, the OIG settled a case involving a physician from Minneapolis, Minnesota, who the OIG alleged had violated his assignment agreement when he created a program whereby the physician's patients were asked to sign a yearly contract and pay a yearly fee for services that the physician characterized as "not covered" by Medicare. In that case, the OIG alleged that because at least some of the services described in the contract were actually covered and reimbursable by Medicare, each contract presented to the Medicare patients constituted a request for payment other than the coinsurance and applicable deductible for covered services in violation of the terms of the physician's assignment agreement. Following the July 2003 settlement, the OIG issued an “OIG Alert” in March 2004 cautioning physicians about their potential liability under the CMPL. The OIG Alert can be found by following this link.