Opinion ID: 613517
Heading Depth: 2
Heading Rank: 3

Heading: Fraudulent Claims to Health Care Benefit Programs

Text: Evidence introduced at trial indicated that Webb submitted claims for office visits and procedures during his 30-day suspension and caused pharmacies to submit claims based on unauthorized prescriptions. In some cases, Dr. Cooper saw a patient, but Webb submitted the claims under his own name. In another case, Webb saw a patient on April 25 but backdated the claim to April 22. Representatives from Blue Cross/Blue Shield of Florida, TRICARE (the health benefit plan for armed services members), and companies that contracted with Medicare and Medicaid testified that the insurers would not pay claims if they knew that the services were provided (or the prescriptions were written) while a physician's license was suspended. Webb's experts agreed that physicians should not see patients, write prescriptions, or bill for office visits while suspended from the practice of medicine. The insurance company representatives similarly confirmed that their companies would not pay for medication that was without legitimate medical purpose. TRICARE's representative stated that the fact that the physician is ordering a service or a prescription drug and that is causing a claim to be submitted to the U.S. Government, that would be considered the same as saying that these services are medically necessary to treat the patient.