Aagam Shah
Section 51291R
Brief #3
US V. Krizek
Facts
• Dr. Krizek owned and operated a psychiatry practice in Washington D.C., while is wife Blanka Krizek oversaw the billing operations.
• The majority of the practice was focused on treating Medicaid and Medicare patients.
• Health Care Financing Administration 1500 Forms contain the patients identifying information, Medicaid or Medicare identification number for the provider and the procedures that are reimbursement is being filed for.
• Dr. Krizek voluntarily participated in the Medicare and Medicaid programs.
• Blanka Krizek filed for forty-five to fifty minute psychotherapy session whenever Dr. Krizek saw a patient, regardless of what the patient’s condition was or the necessary …show more content…
Krizek were valid and necessary. The second issue was about improper billing, as Blanka Krizek had filed for treatments that were longer than administered, or in some cases completely falsified. The real question was that if these two points were violated under the False Claims Act.
Rule
The government won the case, as the False Claims Act was violated when Blanka Krizek and the psychiatry practice submitted Medicare claims. The False Claims Act states that if an individual or group files a claim, which is knowingly falsified, then they are liable for the damages and the additional fines for the fraudulent claims.
Analysis
There were a few obvious mistakes that were made by both Dr. Krizek and Blanka Krizek throughout their Medicare and Medicaid claims process. Dr. Krizek administered treatments and procedures that were not medically necessarily. This was simply to gain more from the government when filing a claim. Dr. Krizek or other medical experts could have argued this. On the other hand, the acts of Blanka Krizek were a blatant disregard of the law, as she falsified billing documents. She had billed for procedures that clearly did not occur, as the patient was not in the office for that length of time. This was easy to prove with the timestamps of procedures and incoming
Section 51291R
Brief #3
US V. Krizek
Facts
• Dr. Krizek owned and operated a psychiatry practice in Washington D.C., while is wife Blanka Krizek oversaw the billing operations.
• The majority of the practice was focused on treating Medicaid and Medicare patients.
• Health Care Financing Administration 1500 Forms contain the patients identifying information, Medicaid or Medicare identification number for the provider and the procedures that are reimbursement is being filed for.
• Dr. Krizek voluntarily participated in the Medicare and Medicaid programs.
• Blanka Krizek filed for forty-five to fifty minute psychotherapy session whenever Dr. Krizek saw a patient, regardless of what the patient’s condition was or the necessary …show more content…
Krizek were valid and necessary. The second issue was about improper billing, as Blanka Krizek had filed for treatments that were longer than administered, or in some cases completely falsified. The real question was that if these two points were violated under the False Claims Act.
Rule
The government won the case, as the False Claims Act was violated when Blanka Krizek and the psychiatry practice submitted Medicare claims. The False Claims Act states that if an individual or group files a claim, which is knowingly falsified, then they are liable for the damages and the additional fines for the fraudulent claims.
Analysis
There were a few obvious mistakes that were made by both Dr. Krizek and Blanka Krizek throughout their Medicare and Medicaid claims process. Dr. Krizek administered treatments and procedures that were not medically necessarily. This was simply to gain more from the government when filing a claim. Dr. Krizek or other medical experts could have argued this. On the other hand, the acts of Blanka Krizek were a blatant disregard of the law, as she falsified billing documents. She had billed for procedures that clearly did not occur, as the patient was not in the office for that length of time. This was easy to prove with the timestamps of procedures and incoming