Medical Fraud Exposed -

Short Dr. Visit – Is this Cheating?

I go to see the Physician, wait in the waiting room for quite a long time. Dr. comes in and does not sit down and stood at the door with his hand on doorknob as if he was getting ready to open the door and leave, making it a short visit. This short visit resulted in a high charge. I made it a point to not stand and tried to have a discussion. After a few minutes I stand which signaled to him that the session was over and he open the door and left, resulting in a high charge.

This doctor charged Medicare $450 for the session, which was a typical example of a short visit with a high charge. He turned in code 99214 Office/Patient Visit Est. Level 4, showcasing how a short visit can have a high charge.

Would this be considered Fraud? Feel free to leave your response via the comment section.

False Claims Act Settlements and Judgments Exceed $2.68 Billion in Fiscal Year 2023

Wow! The False Claims Act exceeded $2.68 billion in settlements and judgments in 2023.

Settlements and judgments under the False Claims Act exceeded $2.68 billion in the fiscal year ending Sept. 30, 2023, Acting Associate Attorney General Benjamin C. Mizer and Civil Division Principal Deputy Assistant Attorney General Brian M. Boynton announced today. The government and whistleblowers were party to 543 settlements and judgments, the highest number of settlements and judgments in a single year. Recoveries since 1986, when Congress substantially strengthened the civil False Claims Act, now total more than $75 billion.

“Protecting taxpayer dollars from fraud and abuse is of paramount importance to the Department of Justice – and these enforcement figures prove it,” said Acting Associate Attorney General Mizer. The impact of the False Claims Act exceeded $2.68 billion also demonstrates its effectiveness. “The False Claims Act remains one of our most important tools for rooting out fraud, ensuring that public funds are spent properly, and safeguarding critical government programs.” Read More

What to Do When Your Patient Records Contain Wrong Information

Errors in patient records can have serious consequences, but you have the power to correct them.

Patient records are the backbone of healthcare, guiding diagnoses, treatments, and insurance claims. But what happens when these records contain errors—wrong diagnoses, incorrect medications, or even fabricated information? These medical records errors can lead to compromised patient records causing misdiagnoses, improper treatments, and financial headaches. In this post, we’ll explore how to address inaccuracies in your medical records, including what to do if a provider refuses to correct them or if you’re no longer their patient.

Can Wrong Information in Patient Records Be Corrected?

Yes, under federal law, you have the right to request corrections to errors in your medical records. The Health Insurance Portability and Accountability Act (HIPAA) grants patients the right to access and amend their protected health information (PHI). According to the U.S. Department of Health and Human Services (HHS), you can request an amendment if you believe your records contain inaccurate or incomplete information.

Steps to Correct Errors:

1. Review Your Records: Request a copy of your medical records from your provider. HIPAA requires providers to give you access within 30 days, though some states have shorter timelines.
2. Identify Errors: Document the inaccuracies, noting specific details like incorrect dates, diagnoses, or treatments.
3. Submit a Written Request: Contact your provider in writing, clearly explaining the errors and providing evidence (e.g., lab results, second opinions) to support your correction. Include your contact information and a request for confirmation of the amendment.
4. Follow Up: Providers must respond within 60 days (with a possible 30-day extension). They may agree to amend, partially amend, or deny your request.

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Your Right to Access Patient Records and What to Do When Providers Fail to Comply

Access to your patient medical records is a fundamental right under the Health Insurance Portability and Accountability Act (HIPAA) in the United States. These records are critical for ensuring continuity of care,

monitoring your health, and detecting potential issues like medical fraud, such as falsified diagnoses or billing for services not rendered. Unfortunately, some healthcare providers may delay or fail to provide these records, which can raise red flags about transparency or even fraudulent practices. In this post, we’ll explore what providers are required to do when you request your medical records, the timelines for compliance, how to request records effectively while creating a paper trail, and your options if a provider doesn’t comply.

What Must Providers Do When You Request Your Medical Records?

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Your Rights Under HIPAA

Most of us believe that our medical and other health information is private and should be protected, and we want to know who has this information. The Privacy Rule, a Federal law, gives you rights over your health information and sets rules and limits on who can look at and receive your health information. The Privacy Rule applies to all forms of individuals’ protected health information, whether electronic, written, or oral. The Security Rule is a Federal law that requires security for health information in electronic form.

HIPAA Right of Access Videos

OCR has teamed up with the HHS Office of the National Coordinator for Health IT to create Your Health Information, Your Rights!, a series of three short, educational videos (in English and option for Spanish captions) to help you understand your right under HIPAA to access and receive a copy of your health information.

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Fort Myers Doctor Agrees To Pay More Than $1.7 Million To Resolve Allegations Of Fraud

Fort Myers, FL – United States Attorney Maria Chapa Lopez announces that Dr. Jonathan Daitch, M.D. has agreed to a civil settlement that will pay $1.718 million to the United States to resolve allegations that he violated the False Claims Act by receiving illegal kickbacks associated with the provision of anesthesia services and by causing the submission of medically unnecessary urine tests. Source

Advanced Pain Management Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Non-Covered Services

APM On October 13, 2020, Advanced Pain Management Specialists, P.A., (Advanced Pain), Fort Myers, Florida, entered into a $24,921.96 settlement agreement with OIG. Advanced Pain Management faces allegations of violating the Civil Monetary Penalties Law, as the settlement resolves allegations that Advanced Pain submitted claims to Medicare for specimen validity testing (SVT) in conjunction with claims for urine drug testing when SVT was a non-covered service. OIG’s Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Gregory Becker with the assistance of Paralegal Specialist Jennifer Hilton, collaborated to achieve this resolution. Source – Office of Inspector General

HealthWatch Pain clinics made millions from “unnecessary” injections into “human pin cushions”

Michelle Shaw and her fiancé, Thomas Truss, said in interviews that Pain MD clinics turned patients into “human pin cushions,” requiring them to agree to unnecessary injections near their spines each month or be discharged. The unnecessary injections made many patients feel like "human pin cushions.” These unnecessary injections transformed Shaw and others into "human pin cushions," a term frequently used during the trial. Shaw begrudgingly accepted the injections so she would not lose access to her painkiller prescriptions, but Truss said he refused the injections and was “kicked out”. Unnecessary injections left patients feeling like “human pin cushions" and their stories were crucial in the trial. Indeed, experiencing such unnecessary injections and becoming “human pin cushions” was a significant aspect of the clinic’s malpractice. Shaw was a key witness in the trial of Pain MD president Michael Kestner, who was convicted of 13 felonies related to health care fraud in October. Shaw and Truss were photographed at their Tennessee home on Jan. 14, 2025. Brett Kelman/KFF Health News. Read More

FBI News and Multimedia

Health Care Fraud – FBI

Health care fraud can be committed by medical providers, patients, and others who intentionally deceive the health care system to receive illegal benefits or payments.

Health care fraud is not a victimless crime. It affects everyone—individuals and businesses alike—and causes tens of billions of dollars in losses each year. It can raise health insurance premiums, expose you to unnecessary medical procedures, and increase taxes.

The FBI is the primary agency for investigating health care fraud for both federal and private insurance programs. See More

Advanced Pain Management (“APM”) Agree to Pay $1 Million to Resolve Allegations They Violated the False Claims Act and Anti-Kickback Statute

United States Attorney Matthew D. Krueger announced today that Advanced Pain Management (“APM”) has agreed to pay $1 million to settle claims asserting violations of the False Claims Act by paying kickbacks and by performing medically unnecessary laboratory tests. APM is a collection of companies including Advanced Pain Management Holdings, Inc. (“APMH”), its wholly-owned subsidiaries APM Wisconsin MSO and Advanced Pain Management LLC, and Advanced Pain Management S.C. (“APM SC”). Read More