1-30-03

(Medical Newswire) A West Virginia physician faces a tougher

health care fraud sentence than he may have anticipated, thanks to 
a

Jan. 14 ruling from the 4th U.S. Circuit Court of Appeals. 



	In a nutshell: Doctors on the hook for overbilling Medicare can

be sentenced on the basis of what they billed for, not just the

typically much smaller amount they actually collected. 



	The case involves Dr. Robert Miller, who was accused of billing

for ordinary new patient visits as more expensive "consultations,"

upcoding, billing for services he didn't provide, and billing for

non-covered services. Medicare, Medicaid and other insurers were 
all

affected by the practices. 



	Miller pleaded guilty to mail fraud, but when it came time to

calculate his sentence, he maintained that the dollar value of his

misconduct should be "the difference between the amount he 
actually

received from Medicare and Medicaid and the amount to which he 
was

legitimately entitled." The feds countered that the proper formula 
was

"the difference between the amount Miller billed (rather than the 
amount

he actually received) and the amount which he says he was 
legitimately

entitled." 



	In United States v. Miller (No. 02-4078), the 4th Circuit sided

with prosecutors, holding that sentencing judges can use the 
intended

loss, calculated via reimbursement requests, rather than the 
actual

loss, when deciding how harsh a penalty to impose. 



	To see the opinion, go to: 



	*	http://pacer.ca4.uscourts.gov/opinion.pdf/024078.P.pdf