As a physician, dedicating your life to ethically and compassionately caring for others unfortunately makes you a tantalizing target for fraudulent schemes. An estimated 3% of healthcare spending gets funneled into healthcare fraud accounts, based on statistics from The National Health Care Anti-Fraud Association. The US government estimates that figure to be more like 10% and suggests that healthcare fraud could cost upward of $300 billion.
Physicians possess the ability to write prescriptions for the gamut of pharmaceuticals, including controlled substances, providing doctors with a very powerful tool at their disposal. Permission to use this tool only comes after years upon years of required schooling and experience. This makes the idea of a forged prescription troublesome on many levels, and it is where pharmacists must serve as guardians against fraud. According to Naveed Saleh, MD, MS, forged prescriptions take various forms, including pilfered prescription pads, prescriptions written by false physicians, or alterations to actual prescriptions.
Dr. Saleh notes that people can try to fraudulently obtain medications by using an excessive number of prescriptions, which are fabricated, from the same physician, false prescriptions for medications with opposite indications (eg, depressants and stimulants), obsessively neat scripts, scripts that appear to be photocopied, or prescriptions lacking standard medical abbreviations. According to Dr. Saleh, physicians can protect themselves from fraudulence by taking actions securing prescription pads safely in their office, using tamper-proof prescriptions, using permanent gel-pen ink, prescribing electronically, and keeping track of their prescription pad inventory.
Attorney Daniel B. Frier, founding partner of Frier Levitt, urges physicians to tread lightly when considering a contract that pays for anything other than medical services rendered. This may include fraudulent schemes posing as authentic business models, like passive healthcare investments or space/equipment leases attached to referrals. It could also involve contracts with groups like drug manufacturers and laboratories.
As such, it is essential that physicians hire a lawyer to examine contracts for fraud, ensuring compliance with Stark, Anti-Kickback, the False Claims Act, and state laws. If a physician were to be found guilty of fraud, they could face dire financial and career consequences. Dr. Saleh notes that, regarding Medicare fraud, physicians could face criminal, civil, and administrative penalties, along with fines and possible imprisonment. Anything from superfluous ordering of tests to billing for missed appointments constitutes Medicare fraud.