Discussion Accused of improperly billing Medicare for treatments

Discussion Accused of improperly billing Medicare for treatments

Introduction on Discussion Accused of improperly billing Medicare for treatments

A member of the hospital’s medical staff has been accused of improperly billing Medicare for treatments done in his office that were not medically necessary.

A subpoena for copies of patient records was received but the subpoena does not include a patient authorization for release of the records. In addition, the subpoena requests all “peer review committee” records pertaining to this physician. Consider the following questions:

1. What must you check before releasing the patient records?
2. What legal concept described in this chapter will determine admissibility of the hospital records into evidence?
3. The defendant’s lawyer objects to the subpoena, arguing that the patient records are “hearsay.” To resolve this issue, identify at least one element that will likely be required in your testimony (or certification of the records).
4. Your hospital attorney objects to the subpoena of the peer review committee materials, citing state law that protects peer review records from discovery. What legal concept describes this protection?
5. In the course of acting on the subpoena, you discover that one of the patient records (which are electronic) has had major sections deleted. Your review of the audit trails determine that a hospital staff member was responsible for the deletions. Under what legal concept could the hospital be subject to liability for the deletions? What should have been done to protect the records?

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