In billing for evaluations of workers' compensation patients, health care providers should be very careful to ensure that they do not misrepresent themselves as a certified Qualified Medical Examiner (QME) on a medical legal evaluation or billing statement. In addition, it is important to ensure that the bills for medical legal expenses have been reviewed so that the criteria for medical-legal billing has been met. A recent case shows how a report by two provider who were not properly certified QMEs led to criminal insurance fraud charges. On May 7, 2019, psychologist Danita Stewart and Dr. Catalino Dureza were charged for allegedly submitting fraudulent insurance claims for Medical Legal Evaluations. They are presumed innocent and charges are not evidence.Dr. Stewart, a licensed psychologist, allegedly submitted 36 fraudulent insurance claims between April 2015 and June 2015 to five different insurers for Medical Legal Evaluations for a total of…
Read more detail on Recent Administrative Law posts –
Related news:
- Sentencing Update: California Doctor Sentenced To 63 Months In Federal Prison For Health Care Fraud. Doctor's Testimony At Trial Resulted in Longer Sentence. Doctor Husband Sentenced to One Year and One Day. In federal court, one important issue is whether to testify or not testify. It is a more critical issue in federal court due to a federal judge's ability to increase the sentence for […]
- California Orthopedic Doctor Charged With State Insurance Fraud for Allegedly Providing Unnecessary and Excessive Medical Treatment for Ortho Patients California county district attorney offices continue to prosecute health care providers for insurance fraud and workers' compensation insurance fraud. They are also using Indictments […]
- Alabama Doctor and 3 Nurse Practitioners Charged With Running Fraudulent Pill Mill By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On December 6, 2017, three nurse practitioners and a doctor were arrested following an […]
- Key Pieces of California Medical Cannabis Evaluations Key Pieces of California Medical Cannabis Evaluations During the previous twenty decades, women and men in the state of California have become increasingly more comfortable with the […]
- Former California Medical Doctor Sentenced To Over Three Years In Prison For Unlawfully Prescribing Oxycodone to a Patient. Judge Noted Doctor Did Not Run a Pill Mill But Feeding One Patient's "Habit" Is Enough. Previously, only physicians who went far over the line and ran "pill mills" got targeted for prosecution. Times have changed. One recent case shows a prosecution for a […]
- Employer must reinstate employee absent on Workers' Compensation Leave upon the certification by civil service commission's medical officer that the individual is fit to perform the duties of his or her position Employer must reinstate employee absent on Workers' Compensation Leave upon the certification by civil service commission's medical officer that the individual is fit to perform […]
- California Pharmacist Charged With Filling Fraudulent Prescriptions for Oxycodone and Hydrocodone. The opioid prescription cases keep coming. On April 11, 2019, a Fresno pharmacist, Ifeanyi Vincent Ntukogu of New Life Pharmacy, in Madera was indicted one count of conspiracy to […]
- California Physician Charged in Self-Referral Case With Felony Insurance Fraud and Perjury for Allegedly Referring Workers Comp Patients to a Laboratory and Surgery Center In Which He Allegedly Had Ownership Interest Referring patients to other business entities that a physician has an ownership interest in can be a violation of the law depending on the type of patient (Medicare, workers' […]
- Sacramento Area Neurosurgeon Charged With Workers' Compensation Fraud and Insurance Fraud For Alleged Upcoding and Ghost Billing For Services Not Provided On April 9, 2019, Dr. Laura Anderson, a neurosurgeon from Carmichael, California, was charged with multiple counts of medical insurance fraud, workers’ compensation fraud, and grand theft. […]
- Massachusetts Court Issues Opinion Declaring that Medical Marijuana Treatments are Not Available in a Workers’ Compensation Claim Medical marijuana is legal in many states, including Massachusetts. This has created novel legal issues for the workers’ compensation system when it comes to whether an insurer is required […]
