New Boston doctor pays fines for alleged Medicare billing fraud
A Texarkana, Texas, physician has agreed to pay $118,000 to settle allegations of improper billing practices for his Medicare patients at his three clinics, announced U.S. Attorney Joseph D. Brown today.
Dr. Donald S. Douglas, 50, operates clinics in Texarkana and New Boston, Texas. The United States’ allegations against Dr. Douglas are contained in a settlement agreement between the parties. According to the allegations, Dr. Douglas’ advanced practice nurses (sometimes referred to as APNs or mid-level practitioners) were hired to assist him with seeing patients in his clinics. Under Texas law, APNs may perform certain duties such as treating and diagnosing patients, performing exams, and other functions. If the services are provided with proper physician supervision, they may be billed to Medicare at the full physician rate. Without direct supervision, APNs may bill Medicare under their own identification number at a reduced rate. The United States alleged that Dr. Douglas billed Medicare for services provided by his APNs at the full physician rate even when a physician was not available to supervise the APNs’ services.
“Pursuing healthcare fraud is a top priority for my office,” said U.S. Attorney Joseph D. Brown. “When providers such as Dr. Douglas enrich themselves at the expense of Medicare, we will hold them to account.”
CJ Porter, Special Agent In Charge, Department of Health and Human Services Office of the Inspector General, Office of Investigation said, “Patients can be assured that the government will investigate outlays of taxpayer funds earmarked for medical care to ensure it is delivered by properly licensed and supervised practitioners and at the correct and allowable rate.”
Under the terms of the settlement agreement, Dr. Douglas does not admit liability. The United States does not allege the services were not provided or that Dr. Douglas’ APNs provided inferior care. Dr. Douglas cooperated with the government’s investigation and will pay $118,000 to settle the allegations.
The Medicare program is a federally-funded health care program that provides health care benefits for persons aged 65 and older or for those who receive Social Security Disability Insurance. Funding is partly provided by Social Security and Medicare taxes. The program is administered by the Centers for Medicare & Medicaid Services (CMS) which is an agency under the United States Department of Health and Human Services.
Medicare relies on the public to inform when fraud, waste, or abuse might be occurring in the health care setting. Fraud may be reported to the Medicare Fraud Hotline at 1-800-HHS-TIPS (1-800-447-8477) and may be done anonymously.
This matter was investigated by the U.S. Department of Health and Human Services – Office of the Inspector General (HHS-OIG), the Federal Bureau of Investigation (FBI), and the United States Attorney’s Office for the Eastern District of Texas. The civil settlement was negotiated by Assistant U.S. Attorney James Gillingham.