Published on
A physician leader/owner of an urgent care clinic in Missouri was recently charged with billing fraud and illegal prescribing of controlled substances. According to the Department of Justice (DOJ), the alleged fraud scheme included the physician billing Medicare and Medicaid for medical services as if he had performed them himself—even though the care was actually provided by assistants who had not yet entered residency and thus were not authorized to file claims. It further alleges that the physician didn’t provide training or adequate supervision of the assistants who provided care to patients. He is also indicted for prescribing controlled substances “outside of the usual course of professional practice and for no legitimate medical purpose to friends, associates, those with substance use disorders, and those with whom he had sexual relationships,” according to DOJ. Investigators have identified as many as 20 individuals who received 15,000 individual dosage units of controlled substances from the physician.
Who’s who in billing practices: “The issue of billing a nurse practitioner or physician assistant’s work under the doctor’s identity is one of the more common red flags and fraud issues that may lead to investigation,” says Alan A. Ayers, MBA, MAcc, President of Urgent Care Consultants and Senior Editor of JUCM. In terms of illegal prescribing, Ayers notes that urgent cares rarely prescribe opioid pain relievers/narcotics, depressants, or stimulants, which are among the most commonly misused drugs overall. See the complete data from the JUCM archive: Few Misused Rx Drugs Prescribed in Urgent Care