Dr. Robert W. Stokes Case Study
Dr. Robert W. Stokes was a licensed, board-certified dermatologist who practiced medicine in Grand Rapids, Michigan. Doctor Stokes was well-renowned and popular in his practice. However, in 2001 federal agents initiated an investigation into Dr. Stokes’s billing practices to determine whether he was up-coding certain outpatient surgical procedures. Up-coding is “billing Medicare and insurers for more expensive procedures than what was performed” (Justia US Law, 2010). The investigation exposed some illegal practices that Dr. Stokes was using when billing Medicare and insurance companies. Some of Dr. Stokes frequently performed procedures were “shaved excisions” which he billed as a costlier “full-thickness excisions, and then performed
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Stokes appealed his conviction on grounds that the district admitted government evidence that related to past audits by medical insurers by mistake (Justia US Law, 2010). Per court documents filed, the government notified Dr. Stokes that it intended to utilize correspondence and audit notifications (the “audit evidence”) to show Stokes’s knowledge of relevant billing rules and specific intent to defraud. This evidence, in relevant part, fell into two general categories: (1) letters from insurance providers addressing relevant billing rules and questioning Stokes’ above-average surgical billings; and (2) documents and testimony concerning audit notifications that Blue Cross Blue Shield of Michigan (BCBSM) sent to Stokes in 2000 and 2002 (Justia US Law, …show more content…
I believe that any provider or staff member that tries or successfully defrauds the government should be punished at the highest level possible. I also know that we have created a society where some medical providers find it very easy to up-code and or charge for higher services than the ones that they are providing. Some feel that they the reimbursement rates are not sufficient for the services that they are providing so they decide to charge codes which pay at a higher rate. I think ethics plays a big part in the way that some medical providers feel about up-coding or up-charging, any ethical provider would see that whether the reimbursement is high or low if you are not providing the services that you are billing for, you are committing a crime and should be tried as a criminal.
Since the case of Dr. Stokes and the revelation that he was using unsanitary medical equipment and put thousands of patients at risk of contracting deadly diseases such as HIV and Hepatitis, State Rep. Michael Sak pushed for tougher penalties and State Sen. Bill Hardiman introduced a bill that “prohibits health care providers from reusing medical devise intended for single use, even if they have been reprocessed” (Shellenbarger, 2008). Under the bill, violators could get up to 10 years in prison and a $50,000
Stokes appealed his conviction on grounds that the district admitted government evidence that related to past audits by medical insurers by mistake (Justia US Law, 2010). Per court documents filed, the government notified Dr. Stokes that it intended to utilize correspondence and audit notifications (the “audit evidence”) to show Stokes’s knowledge of relevant billing rules and specific intent to defraud. This evidence, in relevant part, fell into two general categories: (1) letters from insurance providers addressing relevant billing rules and questioning Stokes’ above-average surgical billings; and (2) documents and testimony concerning audit notifications that Blue Cross Blue Shield of Michigan (BCBSM) sent to Stokes in 2000 and 2002 (Justia US Law, …show more content…
I believe that any provider or staff member that tries or successfully defrauds the government should be punished at the highest level possible. I also know that we have created a society where some medical providers find it very easy to up-code and or charge for higher services than the ones that they are providing. Some feel that they the reimbursement rates are not sufficient for the services that they are providing so they decide to charge codes which pay at a higher rate. I think ethics plays a big part in the way that some medical providers feel about up-coding or up-charging, any ethical provider would see that whether the reimbursement is high or low if you are not providing the services that you are billing for, you are committing a crime and should be tried as a criminal.
Since the case of Dr. Stokes and the revelation that he was using unsanitary medical equipment and put thousands of patients at risk of contracting deadly diseases such as HIV and Hepatitis, State Rep. Michael Sak pushed for tougher penalties and State Sen. Bill Hardiman introduced a bill that “prohibits health care providers from reusing medical devise intended for single use, even if they have been reprocessed” (Shellenbarger, 2008). Under the bill, violators could get up to 10 years in prison and a $50,000