Healthcare Charges Dismissed for a Puerto Rico Physician

A Puerto Rico physician was indicted for allegedly billing for hospital visits during a time period where the hospital was also billing for services rendered. He retained Ronald W. Chapman II of Chapman, Dowling & Mallek and Chapman Consulting Group to investigate the case and defend the federal criminal charges.

During the investigation it became clear that the physician did not sign any form permitting assignment of his billing rights. Under Medicare Regulations a physician is permitted to bill for their services and is also permitted to assign their billing rights to another entity. This is commonly done in the hospital environment where a physician contracts with a physician staffing company and assigns their billing privileges to the staffing company.

Unfortunately for this physician, the owner of the staffing company was double dipping. He paid the physicians a lower rate than customarily paid if billing rights were assigned but represented to the hospital that he was billing for services. Unknown to our client and to the hospital the staffing company unfairly benefited from this failure to disclose.

We retained experts and prepared our case. We were prepared to challenge the Government’s star witness, the staffing company owner. However, merely days prior to trial the Government elected to agree to a deal dismissing the case. The physician remains a practicing physician and is free from the fear of criminal charges or a sentence.

This case stresses the importance of knowledge of Medicare’s rules and regulations as well as the need for a thorough investigation at the outset of any case.