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Will an Indicted Physician Plead Daylight Savings Time as a Defense?
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| Fall behind. Spring ahead. U.S. Senate passes permanent daylight savings time.
But will a Canton, Ohio orthopedic surgeon indicted by a federal grand jury in Boston for his role in a health care fraud scheme plead “the clock” defense? It’s highly doubtful that that would be a winning strategy.
On March 22, 2022, Dr. Olarewaju James Oladipo, 57, of Canton, was indicted on 11 counts of health care fraud for an alleged scheme to defraud health care benefit programs by falsely billing codes for more complex—and thus more expensive—services that were not provided, i.e., “upcoding”.
According to the government, Dr. Oladipo frequently billed for more than 60 patients per day and sometimes more than 90 patients per day. The result was that many, if not most, of Oladipo’s patient visits on such days could have only lasted five minutes or less. However, and here’s the “clock” problem, Oladipo allegedly used billing codes that typically corresponded to visits of 15, 25, 30, or even 45 minutes.
To add further buzz to the indictment, the government also alleged that Oladipo ensured this high flow of patients to his practice by prescribing powerful, highly addictive opioids at a rate that made him one of the top prescribers of such drugs in Massachusetts.
As you probably know, an indictment is just a set of allegations and Dr. Oladipo is presumed innocent unless and until proven guilty beyond a reasonable doubt in a court of law. If convicted, the charge of health care fraud and conspiracy to commit health care fraud provides for a sentence of up to 10 years in prison, one year of supervised release and a fine of up to $250,000.
Nonetheless, the facts of the Oladipo indictment present several lessons for you: - Obviously, upcoding results in fraudulent claims, a crime not only under federal law, but under state law as well. That’s just the beginning of the prosecution “onion” so to speak, because layers and layers of other crimes are contained within the same conduct: mail fraud, wire fraud, the travel act, etc.
- In the context of medical groups, the upcoding problem reverberates like an echo at the Grand Canyon. Was there a compliance plan in place and was it actually operating? When did the group learn of the billing impropriety and when did the 60-day clock start for the return of overpayments from Medicare and Medicaid? What’s the best way to return improperly collected sums? Has someone (like one of the group’s partners, the accountant, or a billing service employee) filed a whistleblower action under the federal or a state false claims act seeking treble damages and monetary penalties for each of what might be thousands of claims?
- Crimes committed by a group physician often result in the group paying a high price for their lack of diligence.
- Adopt and operate an effective billing compliance plan, including regular internal audits. Turning a blind eye (or not making sure that Dr. X can read a clock) is a recipe for turning a group physician’s fraud into your own.
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| | How to Deploy the Secret Sauce of Opportunistic Strategy - Webinar On Demand
They say that COVID-19 has changed the world, creating the "new normal." Many of your colleagues and many hospital administrators are running scared.
Others, leaders like you, know that crisis means opportunity.
Let me provide you with the strategic tools and insights that you need in order to seize opportunities, whether they’re in the context of your current business relationships, the expansion of your business activities, or the creation of new ventures.
You will learn:
• Defense as a defective default: It’s necessary, but not sufficient.
• Exploiting weakness: Drop the guilt and identify opportunity.
• Flat line negotiation is fatal: Understand its myths and limitations.
• Negotiation reality: Learn to identify and deploy on multiple planes to affect the outcome.
• Maneuver: Harness the power of maneuver, both in overall strategy and in specific negotiation strategy.
Others see a crisis and freeze in fear. Learn how to see the opportunities and obtain the tools to increase your odds of obtaining them.
The price to attend is $479. The cost of not attending is astronomical.
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| | | Newsflash: Business Life In the Time of Coronavirus - The Way Out
The coronavsaaairus crisis, especially as it has become politicized, raises a number of business issues and, quite frankly, business opportunities in regard to future disruptive events.
Check out our mini-series, with actionable business lessons for medical group leaders.
Sooner or later this crisis will end. You can’t allow yourself to be too busy, too occupied,
too concerned with current events, to devote time and effort to strategizing for your future.
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Breaches of fiduciary duty and of contractual commitment within medical groups occur every day. The question is, are those duties enforced?
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| | All Things Personal
I called the health systems’ main number looking for someone in the administrative office, only to get voicemail.
On hold for over seven minutes (until I hung up), the voicemail system kept repeating that my call was very important to them. How important could it be if I were placed on interminable hold while their "operators were busy helping other callers”?
In a contest between what someone says and what someone does, always believe the latter, because it’s the truth. Otherwise, you’re mistaking the map for the terrain.
You can apply this lesson literally—what’s your office or your outside provider of your “front”, such as your billing service, actually telling your patients and referral sources, that they’re important or simply pests?
And, you can apply it by analogy in the context of promises made in a business context, such as in the negotiation of a contractual relationship—what’s said is not in the same universe as what’s actually done.
Pay attention to the message that you’re actually getting and pay attention to the message that you’re actually sending.
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| | Help Us Help You With Helpful Content
What tailored content would you most like to see during this time? How can we focus on solutions to your most pressing
strategic concerns?
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| | Podcast Compilation Greatest Hits - Manage Your Practice Edition
We've curated our most popular podcasts on managing your practice into our second compilation album.
Sit back, enjoy, and think about your future.
Listen here. |
| | | | | | We all hear, and most of us say, that the pace of change in healthcare is quickening. That means that the pace of required decision-making is increasing, too. Unless, that is, you want to take the “default” route. That’s the one is which you let someone else make the decisions that impact you; you’re just along for the ride. Of course, playing a bit part in scripting your own future isn’t the smart route to stardom. But despite your own best intentions, perhaps it’s your medical group’s governance structure that’s holding you back. In fact, it’s very likely that the problem is systemic. The Medical Group Governance Matrix introduces a simple four-quadrant diagnostic tool to help you find out. It then shows you how to use that tool to build your better, more profitable future. Get your free copy here.
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| | | Whenever you're ready, here are 4 ways I can help you and your business:
1. Download a copy of The Success Prescription. My book, The Success Prescription provides you with a framework for thinking about your success. Download a copy of The Success Prescription here.
2. Be a guest on “Wisdom. Applied. Podcast.” Although most of my podcasts involve me addressing an important point for your success, I’m always looking for guests who’d like to be interviewed about their personal and professional achievements and the lessons learned. Email me if you’re interested in participating.
3. Book me to speak to your group or organization. I’ve spoken at dozens of medical group, healthcare organization, university-sponsored, and private events on many topics such as The Impending Death of Hospitals, the strategic use of OIG Advisory Opinions, medical group governance, and succeeding at negotiations. For more information about a custom presentation for you, drop us a line.
4. If You’re Not Yet a Client, Engage Me to Represent You. If you’re interested in increasing your profit and managing your risk of loss, email me to connect directly. |
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