PHILADELPHIA - Dr. Joseph Kubacki and Temple University - Of the Commonwealth System of Higher Education ("Temple") have agreed to pay the United States a combined $1,088,574.93, resolving Temple's voluntary disclosure that it improperly billed the United States for medical services provided by residents but that Temple billed as though they had been performed by attending physicians.
The False Claims Act makes it illegal for any person or entity to present a false or fraudulent claim to the United States for payment and/or to retain overpayments that were improperly received. Federal programs only reimburse hospitals for services which attending physicians performed or which attending physicians were present for the critical portions. Those physicians certify that they were present when the critical portion of the services were performed as part of the charting and billing process.
Dr. Kubacki, formerly the Chairman of Temple's Ophthalmology Department, was convicted by a jury on August 22, 2011 of 73 counts of health care fraud, 73 counts of false statements in health care matters, and four counts of wire fraud. The evidence at his trial showed that he had billed the United States for performing services that were performed by residents when he was not even physically present in the hospital. The settlement with Temple pertains both to this fraud and to other fraud discovered in Temple's plastic surgery department, where attending physicians were present in the hospital at the time services were performed but were not actually present for the critical portions of the services for which they submitted claims.
Although Temple trained its physicians in charting and billing requirements, this training did not prevent the fraud from occurring.
“Combating Medicare fraud and overbilling is an increasingly critical issue,” said Memeger. “Every year we lose tens of billions of dollars to Medicare and Medicaid fraud. Those billions represent health care dollars that could be spent on medicine, elder care or emergency room visits. This is unacceptable, and we are committed to working with health care providers like Temple and with the Department of Health and Human Services to eradicate it.”
Temple brought this case to the government’s attention by voluntarily disclosing the improper blling. Memeger complimented Temple on its approach to these issues, stating “When health care providers come forward, forthrightly acknowledge improper conduct, and take steps to prevent that conduct from recurring in the future, everyone benefits. Temple’s decision to disclose the misconduct, to reveal the results of their internal investigation, and to cooperate with our investigation demonstrated that they were serious about providing patients with appropriate medical care and about compliance with the law. Temple also improved its compliance program, promptly terminated its relationship with the physicians implicated in this fraud, and agreed to voluntarily repay both the federal and private payors who had been defrauded. These are critical factors in our decision whether to pursue health care providers in litigation or whether to reach an amicable resolution.”
In light of Temple’s voluntary disclosure and self-audit, and upon the evaluation of Temple’s compliance structure by the Office of the Inspector General of the Department of Health and Human Services, Temple will continue to implement its corporate compliance program without the need for a Corporate Integrity Agreement overseen by the Office of the Inspector General.
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