An allergist is a physician specially trained to diagnose, treat and manage allergies and asthma. In this area of Virginia, with untold numbers of trees, flowers, and grasses, their services are in high demand. Just getting an appointment with an allergist is almost impossible and the first available appointment is often months away. So why are allergists in Roanoke getting into legal trouble with Medicare and Medicaid?
The answer is money…no the better answer is greed!
Three days ago, Allergy and Asthma Associates Inc. [AAA] (now Allergy & Asthma Clinic), a Roanoke-based, family-owned medical practice that billed Medicare and Virginia Medicaid for expensive asthma treatments it did not purchase or improperly administered to patients, paid a lot of money to the government. In June 2020, AAA pleaded guilty in U.S. District Court in Roanoke to criminal health care fraud. Next, they paid the federal government $2.1 million to settle those charges of fraud. According to court documents, between January 2010 and September 2017, AAA submitted improper billings to Medicare and Medicaid for Xolair, an expensive asthma treatment sold in single-use vials. Due to the nature of the drug, many patients receive doses of the drug that require doctors to administer a partial vial of the drug. This results in leftover amounts of Xolair that are not administered to the patient. Medicare and Medicaid allowed providers to bill Medicare Part B and Medicaid one time for an entire single vial of Xolair, which included both the administered quantity, as well as the discarded quantity of the drug from a single-use vial.
In situations where a patient’s dose resulted in a leftover partial vial of Xolair, AAA administered the leftover amount to another patient and the billed Medicare and Medicaid for administering this amount as if it were the entire single-use vial.
From January 2010 to September 2017, AAA billed Medicare $627,540 for Xolair that AAA did not purchase. In addition, AAA received 129 vials of Xolair from Medicaid which is not documented as being used for a Medicaid patient. These 129 vials represent an approximate loss to Medicaid of $88,878.
Dollars paid by Medicare or Medicaid to doctors for fraudulent services is money no longer available for crucially needed health services. Guess who pays Medicare and Medicaid to provide for needed health services? We all do in the form of taxes. Unethical and illegal conduct by doctors is paid for by taxpayers.
Fraudulent billing by doctors, hospitals, and nursing homes is wide spread…and it is a violation of the federal False Claims Act. If you are aware of such fraudulent conduct by healthcare professionals, please let us know. We can help stop it and hold the bad guys financially responsible.