Florida Medicare Carrier's Attempt To Hold Innocent Physician Liable For Overpayments Fraudulently

LAW OFFICES
ANTHONY C. VITALE, P.A.

Law Center at Brickell Bay
2333 Brickell Avenue, Suite A-1
Miami, FL 33129
Tel: 305-358-4500
Fax: 305-358-5113

PRESS RELEASE

Florida Medicare carrier's attempt to hold innocent physician liable for overpayments fraudulently submitted by employer reversed by an Administrative Law Judge.

Anthony C. Vitale of the Law Offices of Anthony C. Vitale, P.A., successfully argued before Miami Administrative Law Judge Catherine Ravinski that Physician Carlos Carranza should not be responsible for Medicare overpayments when such claims were fraudulently submitted by his employer/clinic owner utilizing Dr. Carranza's provider number without his knowledge or consent.

Decision

Social Security Administration, Office of Hearings and Appeals Administrative Law Judge Catherine Ravinski found:

• Florida physician Carlos Carranza was without fault in accepting payments from Medicare for fraudulent claims submitted by a third party, Michael De Paula Arias utilizing Dr. Carranza's Medicare provider number,
  
• that the carrier and the carrier Fair Hearing Officer erroneously applied traditional "reasonable and necessary" overpayment analysis to a fraud case,
  
• had the carrier detected the overutilization before paying the claims, Dr. Carranza would have been saved the ordeal of having to challenge the recovery of the funds, and
  
• Government Estoppel: In January 1999, the Department of Health and Human Services, Office of the Inspector General entered into an agreement with Arias (clinic owner) which estops the carrier from collecting the funds from Dr. Carranza.

Facts

The matter arose from an alleged "overpayment" by Medicare for Part B services billed to the Florida Medicare Carrier, First Coast Service Options, Inc. under Dr. Carlos Carranza's Medicare provider number in 1998 while Dr. Carranza was an employee of Crest Clinics in Miami, FL. There was no dispute that the services billed were never rendered. Miguel De Paula Arias (a.k.a Michael Arias), owner of the Crest Clinics of Miami, FL., fraudulently billed services to Medicare without the knowledge or consent of Dr. Carranza.

Carrier Argument - Negligence

The Carrier alleged that the physician failed to use "due care" in disclosing his provider number to the owner of Crest Clinics and should have protected his provider number like a credit card. Expert, Robert Weatherford testified that it was standard practice in the medical community for physicians to disclose their provider numbers in order to join a physician group practice of a clinic; that the group or clinic would need the doctor's provider number to check his credentials, to verify that the physician had a Medicare provider number and to apply for a group number. Weatherford also testified that in 1994 Florida Medicare disseminated a publication containing a list of Florida physicians provider numbers. Judge Ravinski found:

"Dr. Carranza was without fault. He used reasonable care in disclosing his provider number to [Miguel] Arias under the circumstances. Recovering the funds from Dr. Carranza would be against equity and good conscience. It would be patently unfair to hold Dr. Carranza liable for the criminal activity of a third party, of which he had no knowledge, nor reason to suspect."

"I am an attorney and a physician advocate and can say, with conviction, that the Florida Medicare carrier has been extorting overpayments from physicians for years with callous disregard for the consequences of their actions. Physicians have lost practices, income, their homes and declared bankruptcy."

- Anthony C. Vitale, Esq.