STATE AUDIT Doctor ordered to repay $46,000
The physician's lawyer plans to file a lawsuit against the state auditor.
COLUMBUS -- A Mahoning County physician will have to repay more than $46,000 in Medicaid payments received because of improper and unsupported billing, Ohio Auditor Betty Montgomery said Tuesday.
The audit of Dr. Bruce M. Rothschild, doing business at 5500 Market St., #119, Boardman, was performed at the request of the Ohio Department of Job and Family Services, which administers the state's Medicaid program.
The findings of $46,142 are based on records not made available to auditors and unsupported and erroneous billings for radiology services, Montgomery said.
Auditors said they requested 24 patient medical records, and Dr. Rothschild handed over only 21 of the records.
The audit identified $38,445 in findings, which was the total reimbursement received by Dr. Rothschild for the 972 services claimed for the three patients whose files were not turned over to auditors.
The audit also uncovered $3,075 in findings for the technical component of the 215 radiology services reviewed. Auditors could not verify the doctor had the proper equipment to perform and bill for radiology services. The audit report said Dr. Rothschild did not submit a list of all equipment in the office as requested.
Also, each time Dr. Rothschild billed for radiology services, he billed two units of service for the same patient on the same date, the auditor said.
The audit identified $4,622 in findings in which only one unit of service should have been billed.
In addition to the findings for recovery, the audit also identified costs totaling $14,171 for multiple trigger point injection services that may have been billed incorrectly.
ODJFS will decide whether the questioned costs are repayable, the auditor said.
Lawsuit planned
Atty. David Gerchak, representing Dr. Rothschild, said he's planning to file a lawsuit against the state auditor over the findings.
He said state auditors spent two days looking at files in the doctor's office but were unable to complete their work, needing more time to look at three additional files.
Gerchak said the doctor declined to have the auditors come back a third day and disrupt the office.
Dr. Rothschild, instead, offered to get the records for the auditors, "but the auditors never got back to the doctor to ask for records," Gerchak said.
The lawyer said he contacted the auditor's office in late September about the files and was told that the case was turned over the state attorney general and ODJFS.
Gerchak also contested the findings regarding the radiology equipment, noting that the X-ray equipment was "sitting right there in the doctor's office" for the auditors to see when they were looking at files.
In response to the findings over incorrect billing, Gerchak said the doctor billed for multiple trigger point injection services under old codes because Medicaid wouldn't accept the billing under new codes that were recently established.
Specialty
Dr. Rothschild specializes in the treatment of rheumatoid arthritis and pain management.
In fiscal year 2004, Montgomery's office said that more than $3.5 million in findings and questioned costs have been identified in 36 audits as part of an effort to identify fraud and inefficiencies in the Medicaid system.
"Medicaid is projected to consume nearly 40 percent of Ohio's budget this fiscal year," Montgomery said. "Every Medicaid dollar lost to fraud or waste places more and more pressure on an already tough state budget picture."