Kusserow on Compliance: Is there no limit to fraud cases?

Doctor convicted in connection to a $325 million fraud case

Falsely diagnosing patients with lifelong illnesses

Needlessly subjected patients to unnecessary medications

A Texas rheumatologist was convicted in a jury trial in connection with a $325 million healthcare fraud case. He was found guilty of falsely diagnosing patients with lifelong illnesses and needlessly subjecting them to unnecessary medications such as chemotherapy drugs and then falsely billing insurers for millions of dollars. The DOJ saw this as an extremely egregious case because the doctor falsely diagnosed vulnerable patients—the young, elderly and disabled—with life-long diseases requiring invasive treatments that those patients did not in fact need.

The DOJ further noted that many of the patients, including one as young as 13, suffered physical and emotional harm as a result of the chemotherapy injections, hours’ long intravenous infusions, and other excessive, repetitive and profit-driven medical procedures. Also noted was that the evidence presented at trial showed that to obstruct and mislead a federal grand jury investigation, the doctor falsified medical records.

 

Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

Connect with Richard Kusserow on LinkedIn.

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