Atlanta doctor and staff face Medicaid fraud charges

Anyone who has tried to decipher a hospital bill or an insurance company’s explanation of benefits can attest to how complicated our system of paying for health care can be. Determining what portions will be covered by what entities depends on the physician network, insurance plan and the specific billing code for the procedure. When Medicare or Medicaid is involved, it adds another layer of complexity.

Many health care providers would like to be able to focus on their primary role of making sick people well. It would seem like curing those that are ill should be sufficient to be a successful health care provider. But due to the complicated and heavily regulated nature of our health care system, a doctor who is not extremely diligent in her billing procedures may be susceptible to charges of Medicaid fraud.

A news report today tells the story of an OB-GYN who was charged with fraud last week. Prosecutors allege that the doctor and his staff billed Medicaid for more services than were actually provided. A Fulton County grand jury indicted the doctor and two of his staff last Tuesday.

In addition to the fraud charges, the grand jury indictment also included charges for conspiracy and practicing medicine without a license. Prosecutors allege that the doctor knowingly permitted one of his staff members to engage in activities that constitute the practice of medicine despite the fact that the staff member did not have a medical license.

While alleged overbilling may seem more like an accounting error than a serious criminal matter, these charges have the potential for serious consequences. It is important that anyone facing charges of insurance fraud or Medicaid fraud consult with an experienced attorney who understands the complex world of medical billing and Medicaid regulation.

Source: CBS Atlanta News, “Atlanta OB-GYN and former staff indicted for Medicaid fraud,” Mandi Milligan, Nov. 28, 2011