Rick Scott health care company accused of overbilling Medicare

Two weeks before Florida’s primary, new allegations of improper Medicare billing by Solantic, a health care company co-founded by Rick Scott, have surfaced, in addition to charges made by former Solantic doctors that their names and licenses were used without their consent. Within hours of being pressed for answers by The Florida Independent, Solantic officials and Scott held hastily arranged press conferences Tuesday to rebut the charges.

Two doctors — both former employees of Solantic, the chain of clinics launched by Scott and in which he is a majority investor — allege that Solantic repeatedly used their name and medical license information without their permission or knowledge. Both doctors state that by allegedly misappropriating their information, the company was able to keep clinics operating in contravention of state law.

One of the doctors asserts that he also came upon evidence of billing irregularities involving Medicare, which, if true, would be the second time a Scott-run company was accused of improperly billing Medicare.

The two doctors don’t know each other, and didn’t work at Solantic at the same time.

Dr. P. Mark Glencross began working at Solantic in 2003 as its chief medical officer. He filed a lawsuit in 2008 claiming the company used his information without his knowledge to license six different clinics. He states in his lawsuit that he left Solantic shortly after he discovered the incidents of “unauthorized misappropriation” in 2004.

Dr. Randy Prokes worked at Solantic from 2004 to November of 2009 as an on-site doctor treating patients at one of its clinics. He says that he saw documents listing his name on billing forms and medical records at clinics he never visited, with patients he never met. When he cross-referenced those records with patient information, he says he saw that the patients were treated mostly by doctors hired on a temporary basis. Prokes alleges Solantic improperly used his license to cover clinics without his knowledge or consent.

In interviews with The Florida Independent, Prokes did not offer documents to substantiate his claims. The privacy of patients’ records is protected by federal law. But three former Solantic employees corroborated his account. After looking into the alleged unauthorized use of his name and license, Prokes says that he also came upon records indicating that Medicare was not being billed properly when a nurse practitioner was working alone at a clinic.

Nurse practitioners are allowed to work alone at a clinic, as long as they have a collaborative agreement with a doctor to operate under his license. But if a nurse practitioner treats a patient when there is no doctor on site, Medicare will only pay 85 percent of the scheduled fee for those visits. Prokes says that the records he saw showed that Medicare was being charged 100 percent for those visits.

In some circumstances Medicare will pay the full amount when a nurse practitioner working alone sees a patient, including if the nurse is under the direct supervision of a doctor as part of a patient’s treatment plan. But generally it is not allowed. “This is a problem area that we do see,” says Marc Wolfson, public affairs director at the Health and Human Services Office of the Inspector General. “A company will bill Medicare for services not by the physician who signs a claim, but by other people working in the company. That is a violation of federal regulations.” Wolfson emphasizes he is not commenting on Solantic, and adds that only an investigation could determine if there were violations and whether they were criminal or civil.

Prokes says he’s concerned about the position in which the company put him. “I don’t think anybody could hold me liable for malpractice, because I didn’t see the patients,” he says. “But maybe I could be held accountable for some kind of fraud.”

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