Becker's ASC Review

95 HEALTHCARE NEWS Pain physician's alleged billing fraud not covered under the anti- SLAPP statute By Alan Condon A California appellate court has rejected an anti-strategic lawsuit against public participation motion filed by Sonny Rubin, MD, aer Allstate Insurance alleged that the physician prepared fraudulent medi- cal reports and billing statements to support insurance claims, according to a court opinion posted on Justia. Six notes: 1. Dr. Rubin controls two medical companies — Sonny Rubin, MD, Inc., and Coastal Spine and Orthopedic Specialists in Newport Beach, Calif. — with a portion of lien patients referred to him by attorneys, according to court docu- ments. 2. In filing his anti-SLAPP motion, Dr. Rubin argued that the preparation and submission of the medical reports and bills to insurance were protected litigation activities. 3. However, Dr. Rubin's practice failed to provide evidence establishing the written medical reports or billing statements for its lien patients were made "in anticipation of litigation contemplated in good faith and under serious consideration," according to court documents. 4. e court said that filing alleged false insur- ance claims is generally not protected right-to- petition activity under the anti-SLAPP statute. 5. The court ruled that Dr. Rubin's reports and bills were not protected activity because they expressly reference settlement, which acknowledges the possibility that Dr. Rubin's patients will resolve claims outside of the court; there was no evidence the reports and bills were intended to be evidence of dam- ages in litigation; and physicians regularly prepare notes or reports and bill for their treatment. 6. e court concluded that the documents were prepared in the regular course of business and therefore are not protected activity. n Orthopedic surgeon pleads guilty to workers' compensation fraud By Laura Dyrda A Louisiana-based orthopedic surgeon has pleaded guilty to workers' compensation fraud, according to the U.S. Justice Department. Robert Dale Bernauer Sr., MD, waived a grand jury indictment and pleaded guilty to participating in a fraud scheme between 2011 and 2017, according to a July 30 statement from the Justice Department. Dr. Bernauer admitted to dispensing pain creams and patches to workers' compensation patients in exchange for 50 percent of the profits collected by an unnamed Arkansas-based company, according to prosecutors. The company billed for Dr. Bernauer's prescriptions and submitted false claims to the workers' compensation program covering federal employ- ees as well as private insurers, and the co-conspirators violated Louisiana law by knowingly dispensing the topical creams and products from the clinic without the appropriate license, the Justice Department said. In his guilty plea, Dr. Bernauer said he ignored red flags about the busi- ness arrangement and collected about $1 million from the scheme. Dr. Bernauer agreed to pay $664,176.30 directly to the U.S. Labor De- partment within 30 days as part of his plea agreement. He will also pay $361,096.70, which will be distributed to insurers that experienced loss from the scheme. Walmart files to provide healthcare in 37 states as it pushes deeper into telehealth By Hannah Mitchell Walmart has filed paperwork to operate its healthcare business in 37 states, Insider reported July 19. A Walmart spokesperson told Insider in June that the filings are to oper- ate its telehealth services after it completes its acquisition of virtual care provider MeMD. "We've expressed our interest in offering telehealth via an acquisition that is pending regulatory clearance, and these filings are related to that effort, not physical Walmart Health locations," the spokesperson said. However, Walmart did not confirm that these filings are also for its tele- health venture. In April and May, Walmart filed to conduct its healthcare business in 16 states. In June and July, the retail giant added another 17 states, accord- ing to public documents. Aside from operating 20 medical clinics in Arkansas, Georgia and Illinois, Walmart in the last few months has been working to posture itself as a one-stop-shop for comprehensive medical care. Walmart launched a free digital wallet that people can use to store and share health information, such as COVID-19 vaccine records. On June 29, Walmart said it will offer a less expensive private label version of analog insulin for diabetes patients who struggle to afford their medication. n

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