Recent Court Cases Against Physicians

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Questions...toll free....800-724-2627

Case 1: Four-Physician Cardiology Group
A four-physician cardiology group in Mississippi was targeted by the Center for Medicare Services (CMS).

After an initial review of 159 claims, CMS determined that 30 were improperly paid. Based on the error rate, CMS demanded more than $2.4 million be repaid to the Medicare program within 30 days.

Fortunately the group had purchased the Regulatory Compliance Insurance coverage and immediately reported the audit.
The response to CMS resulted in the overpayment amount being reduced to less than $3,000.
The cost of the expert defense work was significant, but was fully covered by the insurance policy minus a small deductible.
The cost of the insurance was less than $7,000 for the group.

Case 2: A Sole New Jersey Physician
A Fairfield, New Jersey physician (now retired) paid $40,000 to resolve his liability under the Civil Monetary penalties provisions applicable to false claims and kickbacks.
He did not have regulatory insurance and had to absorb the full cost.

Case 3: Delaware Cardiology Group
This group paid $611,250 to resolve their liability under the CMP provisions applicable to kickbacks and physician self-referrals.  They did not have regulatory insurance.