Question

You are the Compliance Officer of a 230-bed teaching hospital. You have just read a newspaper article reporting that a physician on the hospital's medical staff has been charged with violations of the False Claims Act in his private practice. The charges include upcoding and billing for unnecessary services. Do you believe that there is any way that the hospital could be implicated in the physician's misdeeds? What is your first reaction to receiving this information? If it appears that the charges are legitimate and some disciplinary action is necessary, what are your options? When you suggest suspending the physician from the medical staff for 6 months, the Chief Medical Officer reminds you that the physician refers a large number of patients to the hospital Does this make a difference to you?

Answer 1

Do you believe that there is any way that the hospital could be impli Gled is the physician's misdeeds I don't Believe the hospital could be implicated w115 the physician's misdeeds however he could be doing the same kind of scam with hospitals palients with the help of the person in Charge of the clams but the Hospital as an institution can not be responsible for the acts of 3 ndividuals. 1. What as your frist reaction to receiving this 107 ปรับ ? my first reaction is to check the Gases the Physician took ownership for the last year. I would create a Commission to review this Information and take a deciston base on our findings. If at appears that the Charges are legitimate and some duciplinary achool is necessary what are your opinions ? - I would provide unpaid leave of ablence for - 1 month so our disciptnary board can take a decision of Terminaling his contract our returning too Hoca CS Scanned with a to he Hospitsi. CamScanner

When you suggest scespencing the physician from The medical stitor 6 months le chéit medicd elliced remonds you that the physician reffers a large akember of patients to the hospital. Does this make a clifference to you? - I would repped the exact Number of patients the physician in fact refers to our hospin if the Number is over 85% I would not suspend him because it would impact directly on the hospitals revenue. f is Lower I would suspend him but only after we have hared another physician who could refers patients to us Bottom line is he broke the Law and he can not be trusted. Scanned with CamScanner