Doctor learns $300,000 lesson about billing drugs to Medicare

by: Laura Evans, CPC May 25, 2017

Normally the old adage, “waste not, want not,” would be a reliable rule of thumb to live by. But when you’re trying to stay compliant with Medicare billing rules for drugs and supplies, wasting leftover medications is often the better idea -- as federal prosecutors recently showed a corner-cutting neurologist.

An ingenious plan by Ladue, Mo. neurologist Sherry X. Ma. M.D., of AIMA Neurology LLC to repurpose leftover injectable drugs ended up costing her practice nearly $300,000 in a recent civil settlement with the U.S. Attorney of the Eastern District of Missouri.

The meds in question were vials of Botox® and Myobloc® that Dr. Ma received at no charge for use on patients with private health insurance.

After treating those patients, Dr. Ma decided to store the leftover meds instead of discarding them, subsequently using them on her Medicare patients. She then billed Medicare for the drugs as though she had purchased the vials, and logged incorrect lot numbers for the drugs into the patients’ medical records.

“Federal law generally prohibits health care providers from seeking reimbursement from Medicare for items that they obtained at no cost,” a release from the U.S. Attorney pointed out.

Blog Tags: anti-fraud, compliance

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