In order to provide medical care, one must be trained and educated, at a minimum. In certain cases, they must also be licensed and/or have a certification.
Let’s focus on physicians.
Each state has a Medical Board and associated regulations surrounding the requirements to obtain and maintain a medical physician’s license. In Ohio, the state law requires a medical practitioner who performs certain medical services to be licensed in Ohio.
A recent Department of Justice case found several Ohio men to be liable for submitting false claims and for fraud when practicing medicine without a license in Ohio. Cecil Alexander Kent, Jr., pled guilty to one count of conspiracy to commit healthcare license fraud, two counts of healthcare fraud and five counts of making false statements relating to healthcare matters. Kent admitted in court while he was employed at B&M Visiting Doctors PLC., and while he was unlicensed in Ohio, he treated patients and falsified related patient records, including medical documents. He falsified prescriptions for controlled substances he wrote using the name and U.S. Drug Enforcement Administration number of a licensed physician. In addition, Kent knew Medicare did not pay for patient visits performed by a non-licensed physician. With such knowledge and intent, he falsely and, in a fraudulent manner, submitted to Medicare such claims through B&M.
Separately, Charles McRae, an unlicensed physician and co-owner of B&M along with Alvin Williams, an unlicensed physician, were charged and pled guilty for their participation in this scheme. The fraud totaled approximately $6.2 million in Medicare fraud.
Lessons learned:
In order to perform and bill for certain medical services, a person must be properly licensed. Such licensure must be maintained and kept current during the provision of services. Further, a medical professional must use his/her own DEA license/number and not that of someone else, in order to lawfully prescribe. A submission for reimbursement of federal healthcare dollars for unlicensed care is considered both a false claim and fraud. Such actions will be prosecuted to the fullest and those persons found liable or who pled guilty will suffer criminal and possible civil penalties.
Written by Michael Rosen, ESQ
ProviderTrust Co-Founder, mrosen@providertrust.com
Michael brings over 20 years of experience founding and leading risk mitigation businesses, receiving numerous accolades such as: Inc Magazine’s Inc 500 Award and Nashville Chamber of Commerce Small Business of the Year
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