Too many physicians still believe that federal and state fraud authorities are only interested in large health systems and pharmaceutical companies. As clear evidence to the contrary, however, the U.S. Department of Justice announced this week that Dr. Fred Dweck, a retired Miami physician, has been sentenced to 24 months in prison and 3 years of supervised release for his role in a scheme to receive kickbacks from home health agencies in exchange for referrals for unnecessary Medicare services. According to the release, during a three year period, Dr. Dweck referred more than 800 patients for unnecessary homecare and physical therapy services. In addition to his prison sentence, Dr. Dweck has been ordered to pay $22 million in restitution jointly and severally with his co-defendants and co-conspirators to the Medicare program.

While Dr. Dweck’s punishment reflects the egregious nature of the scheme with which he was charged, physicians who treat Medicare patients and order/certify services covered by Medicare should take care to ensure that those services meet applicable medical necessity guidelines and further, that medical necessity is clearly documented in the record.  Billing for medically unnecessary services can result in overpayments and worse, allegations of fraudulent or abusive billing.  It’s also a good idea to have your documentation, coding and billing reviewed on a periodic basis by an independent billing/coding expert (engaged by legal counsel) to ensure compliance with Medicare and commercial payor rules and standards.