Ethics, Fraud, and Internal Audit at Ut Southwestern

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There are many taxpayer supported medical schools in this country, most receiving their fees for services through Medicare and Medicaid. The Department of Health and Human Services requires that medical students who have graduated to the resident status have a teaching physician physically present when performing key portions of patient service to be able to bill those services to Medicare. In fact, the patient chart must be legibly signed by the attending physician that they were present and supervising the specific service in order to bill Medicare ("Guidenlines for teaching," 2011).

According to an article in the Dallas News, a former employee by the name of Jack Mooney was hired in 1991 by the University of Texas Southwestern Medical Center as a reimbursement manager to make sure that all medical billings submitted to Medicare and Medicaid were properly documented and billed (Dunklin & Moffeit, 2010). For example, that the teaching physicians were physically present when residents were performing services to meeting the required mandates for Medicare billing. He discovered that was not the case and took the information to his supervisors. Stricter policies were put into place for the departments to follow to make sure that all employees were following the necessary guidelines. In 1997, when Mr. Mooney was the director of UT Southwestern’s billing compliance office, he was still seeing and documenting the same problems. Mooney left the college in 1998 shortly after filing a federal whistle-blower lawsuit.

The earliest documentation that can be found of UT Southwestern’s Internal Audit departments involvement comes in a 2003 when they approve of some of the college’s compliance policies, but noted that they do not have a policy in place to review reimbursement claim documents. Dallas News notes that six faculty meetings were held during 2007 and 2008 in which billing concerns were discussed. The Internal Audit Annual Reports for those years do not...
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