Temple, doc pay $1M to settle fraud claims

Temple University and a former chairman will pay the federal government more than a combined $1 million to settle claims that it improperly billed Medicare for services that were supposedly to be performed by attending physicians when they were really performed by residents, in violation of the False Claims Act.

Medicare should only reimburse hospitals for services which attendings perform or for which they are present during critical portions of the services, the Eastern District of Pennsylvania's Attorney's Office explained yesterday.

Former Chairman of Temple's Ophthalmology Department Joseph Kubacki, however, billed for more than $1.5 million for resident-performed services in which he was not even in the hospital for, the court found in August 2011. A jury convicted Kubacki on 73 counts of healthcare fraud, three counts of false statements in healthcare matters and four counts of wire fraud.

This settlement follows a similar case in 2007 regarding three plastic surgeons who allegedly submitted claims for services they were not present for. Amithaba Mitra, Rhoda Powell and Julia Spears have since left Temple, the Philadelphia Inquirer reported.

Temple brought this recent case to the government voluntarily, disclosing the inappropriate billing.

"When healthcare providers come forward, forthrightly acknowledge improper conduct, and take steps to prevent that conduct from recurring in the future, everyone benefits," U.S. Attorney Zane David Memeger said in the statement. "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 promptly ended its relationship with the physicians implicated in this fraud and improved its compliance program, Memeger said. The case highlights the fact that even if the hospital trains physicians in charting and billing, providers still can commit fraud.
Temple is paying $412,474, and Kubacki is paying $676,100.

For more information:
- read the DoJ statement
- see the Philadelphia Inquirer article

Related Articles:
Feds investigate Dallas hospital, docs for fraud
Hospital exec heads to prison for bribery
Billing for E/M services susceptible to Medicare fraud
Tenet to pay $43M to settle Medicare fraud allegations
HHS to scammers: Don't even think about Medicare fraud