Medicare Case Underlines Importance of Physician Compliance With All Rules When Claims Are Filed

Abstract

THIS NEW YEAR begins with yet another cautionary message for physicians. It accompanies news of what is held to be the largest settlement ever in a Medicare fraud case—$111.4 million— just reached with a plea of guilty by National Health Laboratories, Inc, La Jolla, Calif, one of the major medical laboratory chains in the country, to charges of improper claims involving clinical testing procedures and the Medicare program. The settlement includes a fine of $1 million and $10.4 million in payments to state Medicaid programs as well as $100 million in repayments to Medicare, Medicaid, and the Civilian Health and Medical Program of the Uniformed Services. The president and chief executive officer of National Health, Robert E. Draper, also pleaded guilty to two counts of fraud and resigned from the company. He faces a possible maximum 10 years in prison and a $500 000 fine. Two Tests The case initially