On April 8, 2014, the long-awaited report on Medicare payments to physicians was released. It is the most detailed report showing physician billings under Part B in the fifty-year history of Medicare.
This report was ordered to be released last year and will be studied by many in the health care industry. Some of those persons examining the report will be fraud investigators looking for payments that may have been made by filing false claims. With such an extensive report, the concern is real for all physicians, not just those specialties acknowledged in the report.
The False Claims Act is one of the government's most potent tools for recovery of Medicare funds improperly paid. Penalties under the FCA are calculated on a "per claim" basis and require reimbursement of three times the amounts paid and civil penalties of $5,500.00 to $11,000.00 per claim.
It is imperative that each physician practice have a compliance plan in effect and perform regular compliance audits of its billing practices and its relationships with hospitals, medical device manufacturers, and others in the health care industry. False claims can arise from arrangements that violate the Anti-Kickback and Stark laws.