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IIT Dr Smith Clinic Internal Medicine Group Jane Billing Fraud Case Study

IIT Dr Smith Clinic Internal Medicine Group Jane Billing Fraud Case Study

Question Description

Dr. Smith was recently hired into the XYZ Clinic’s Internal Medicine Group as its sixth physician. She has recently completed her residency and is eager to enter into private practice. Dr. Smith is introduced to Jane and Jon, two employees of the billing staff for the practice. Unknowing to Dr. Smith, Jane financially assists the practice in several ways. First, She bills procedures by using individual codes whenever she can instead of comprehensive codes as this provides greater reimbursement for the same services. Dr. Smith’s credentialing process has not yet been completed, so Jane has decided to bill Dr. Smith’s services under the Medicare number of Dr. Doe (another XYZ Clinic physician) until Dr.Smiths credentialing process has been completed. Finally, Jane is habitually submits claims more than once if she isn’t sure whether or not it has already been submitted. Is Dr Doe liable for any of these occurrences even though he is unaware that this is taking place?

Is Jane Committing any type of fraudulent billing? If so what types? Can she be held liable for these actions?


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