Two doctors are in the news - one for a conviction and one for a large settlement.
In the Chicago area, a jury convicted vascular and thoracic surgeon Dr. John Natale of two felony counts of making false statements in reports relating to health care benefits and services. He was acquitted of two counts of health care fraud and one count of mail fraud, according to the U.S. Attorney's office in northern Illinois.
Natale faces up to five years in prison and $500,000 in fines, the U.S. Attorney office stated.
The doctor "prepared false post-operative reports that, among other things, contained extensive details about the aneurysm repairs that he never performed and falsely described the surgeries he did perform as being more complex and elaborate than they actually were," the U.S. Attorney's office stated.
"In the case of one patient whose medical condition deteriorated a year after Natale operated, another surgeon testified that he had to untangle the falsehoods in Natale's records, which, if relied upon, would have had a series impact on his subsequent treatment of that patient," the U.S. Attorney's office stated.
In a separate case in Kansas, Dr. Roger Evans and his company EECP Heart Center of Kansas Inc. will pay $1.5 million to settle allegations related to enhanced counterpulsation therapy, according to the U.S. Attorney's office in Kansas.
Evans submitted claims from July 2005 through June 2009 for services when he was not present at the clinics and did not provide direct supervision of the procedures, which Medicare requires for enhanced counterpulsation therapy, the U.S. Attorney's office stated.
Evans and his company do not admit any wrongdoing, the U.S. Attorney's office stated.
RACs Post 14 Issues
In recovery auditor (RAC) news, regions A, C and D have been active. Region A RAC DCS Healthcare Services posted two issues relating to MRI scans applicable to Connecticut and New York. Region C RAC Connolly posted 11 issues for inpatient hospitals, outpatient hospitals, home health agencies and physicians. Region D RAC HealthDataInsights posted one issue for physicians about allergy immunotherapy and E/M services.
About the Author
Karen Long is the compliance product manager for DecisionHealth and oversees products that relate to fraud and abuse and HIPAA compliance for physician offices and home health agencies, and accreditation compliance for hospitals. In her almost four years at DecisionHealth, Karen also has been the compliance editor and a reporter for Home Health Line, nation's leading independent authority on home healthcare business, regulation and reimbursement.
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