Dr. Joseph Kubacki and Temple University Of the Commonwealth System of Higher Education (“Temple”) have agreed to pay the United States a combined $1,088,574.93, resolving Temple’s voluntary disclosure that it improperly billed the United States for medical services provided by residents but that Temple billed as though they had been performed by attending physicians. The settlement resolves charges brought in response to the voluntary disclosure by Temple of the improper billing in question.
The False Claims Act makes it illegal for any person or entity to present a false or fraudulent claim to the United States for payment and/or to retain overpayments that were improperly received. Federal programs only reimburse hospitals for services which attending physicians performed or which attending physicians were present for the critical portions. Those physicians certify that they were present when the critical portion of the services were performed as part of the charting and billing process.
Dr. Kubacki, formerly the Chairman of Temple’s Ophthalmology Department, was convicted by a jury on August 22, 2011 of 73 counts of health care fraud, 73 counts of false statements in health care matters, and four counts of wire fraud. The evidence at his trial showed that he billed the United States for performing services that were performed by residents when he was not even physically present in the hospital. The settlement with Temple pertains both to this fraud and to other fraud discovered in Temple’s plastic surgery department, where attending physicians were present in the hospital at the time services were performed but were not actually present for the critical portions of the services for which they submitted claims.
Although Temple trained its physicians in charting and billing requirements, this training did not prevent the fraud from occurring.
In light of Temple’s voluntary disclosure and self-audit, and upon the evaluation of Temple’s compliance structure by the Office of the Inspector General of the Department of Health and Human Services, Temple will continue to implement its corporate compliance program without the need for a Corporate Integrity Agreement overseen by the Office of the Inspector General.
This resolution is part of the Eastern District of Pennsylvania’s Special Focus Team Health Care Initiative. The case was investigated civilly by the Department of Health and Human Services Office of the Inspector General and Assistant United States Attorneys Paul Kaufman and Susan Dein Bricklin. Dr. Kubacki was prosecuted criminally by Assistant United States Attorneys Anthony Kyriakakis and Matthew Hogan.
For more details, see United States Settled With Temple University and Dr. Joseph Kubacki Over Improper Billing.