Alleged fraud uncovered during EMR training

In a recently unsealed lawsuit in Florida, Dr. Juan Domingo, an internist formerly with Lee Physician Group, a division of Lee Memorial Health System, accuses his past employer of not only intentionally defrauding Medicare but also of terminating him from the practice in retaliation for investigating the alleged upcoding of his colleagues.

Especially interesting about this case, however, is the way Domingo discovered something was amiss--by accident, he said, while learning the ropes of his group's new electronic medical records (EMR) system. According to the report in the Naples Daily News, Domingo had asked the group's medical director if he could look at the electronic patient notes and records entered into the system by his colleagues so he could become more proficient at it, and he stumbled upon several instances of upcoding. At that time, in September 2008, Domingo confirmed his suspicions by checking the codes against the practice's schedule and reported his findings to the group's legal department shortly thereafter.

By January 2009, Domingo was fired, according to the hospital system, for violating policies unrelated to the allegations. It isn't clear why the ensuing May 2009 case is being unsealed for public scrutiny only now; however, the U.S. Attorney's Office has declined to intervene and the hospital system has yet to be served, the newspaper reports.

To learn more:
- read the article from the Naples Daily News

Related Articles:
Physician alignment, end-user support vital to EHR success, CMIO says
EHR struggle drives doc to quit practicing
Sheriff found guilty of retaliating against nurse whistleblowers
Prime Healthcare accused of Medicare fraud, seeking legal action against press