Dr. Sarah E. Forbes; License # 0101012203
Nature of Complaint:
Forbes, MD, PC, a professional corporation owned by the physician, from January 2005 through March 2006 engaged in fraudulent and deceptive insurance billing practices regarding Patients A-BB. Forbes, MD, PC routinely upcoded office visits and falsified medical records to support higher levels of billing and/or billing for services not rendered, specifically using Current Procedural Terminology Code 99354.
The physician admitted that between 2005 and 2006 her office overbilled for services rendered to Patients A-BB. The physician claimed that the overbilling was due to being misinformed by staff about the use of a time calculator box to determine level of services. The physician stated that in 2008 she ceased using this billing method and has hired a coding consultant to ensure proper billing.
The physician after an investigation and audit was conducted by the United States Department of Health and Human Services entered into a Settlement Agreement with the United States. The physician agreed to pay approximately $430,757.36 in settlement of certain civil claims asserted by the United States for the period of 07-01-2003-06-30-2006.
The physician hired an independed coding consultant to review her practice. The consultant stated that she has done a complete overhaul of the physician's office billing and medical recordkeeping practices and conducts random, monthly audits to ensure continued compliance. The consultant advised the physician to never bill CPT codes 99354/99355 unless the physician has the consultant's consent.
The physician from approximately 11-07-2006 to 12-11-2007 treated Patient CC on multiple occasions to include prescribing medications and ordering diagnostic studies and laboratory work. The physician failed to perform or document a physical examination or assessment, note patient complaints or symptoms, formulate a diagnosis or treatment plan, and/or provide appropriate follow-up care.
The physician prior to 03-11-2008 routinely pre-signed blank prescriptions to be used by the physician's nurse practitioner and often leaving them in unsecured areas in the office. The physician ceased this practice upon being informed by a DHP investigator that this was not permitted.
The physician provided the Virginia Board of Medicine with a false birthdate on documents related to her medical license and also provided a false birthdate on a reappointment application for the period of May 2007-May 2008 for Riverside Regional Medical Center. The physician claims that she no longer misrepresents her age.
The physician prescribed controlled substances including narcotics, benzodiazepines, barbituates, antidepressants, and sleep aids to Patients DD and EE without first performing a proper physical examination, evaluation or assessment. The physician regularly prescribed narcotics to Patients DD and EE often in response to telephonic requests from the patients. The physician regularly failed to document these prescriptions or the reasons in the patients medical records. The physician failed to develop a comprehensive treatment plan and/or to review and monitor the efficacy of treatment for patients including monitoring and managing Patient DD and EE's usage of narcotic medications. The physician prescribed controlled substances to Patient EE who the physician knew or should have know had become addicted to or dependent upon her medications. The physician did not appropriately treat or refer the patient for treatment of substance abuse. The physician failed to coordinate treatment and follow-up with other physicians or consistently obtain medical records from other physician involved in the care of Patients DD and EE. The physician failed to appropriately recommend or prescribe treatment modalities to Patient DD other than the prescription of controlled substances.
The physician admitted that she did not utilize pain scales, drug screens or pain management contracts.
The physician admitted that she had not kept proper records for treating employees and their family members.
Action Taken-Amended Order-Nunc Pro Tunc 12-01-2009
The Virginia Board of Medicine has placed the physician's license on Indefinite Probation subject to the following terms and conditions:
- The physician is prohibited from prescribing, dispensing or administering Schedule II or Schedule III controlled substances.
- The physician shall notify the United States Drug Enforcement Administration and have her current DEA registration amended to reflect the restriction.
- The physician within six months shall submit satisfactory proof to the Board that the physician has completed ten hours of board approved continuing medical education in proper prescribing .
- The physician within six months shall submit satisfactory proof to the Board that the physician has successfully completed twelve hours of board approved continuing medical education in medical recordkeeping .
- The physician within nine months of completing the continuing medical education requirements, the physician's practice shall be subject to an unannounced inspection by an inspector/investigator of the Department of Health Professions.
- The physician shall submit an inspection fee in the amount of $500.00 to the Board within thirty days of completion of the unannounced inspection.
- The physician within six months shall submit proof of passing the Special Purpose Examination administered by the Federation of State Medical Boards and shall ensure that a copy of the results are submitted within thirty days to the Board.
- The physician within thirty days shall provide the Board with written certification that the physician has read and shall comply with the laws governing the practice of medicine and surgery (Title 54.1, Chapter 29 of the Code); the Regulations Governing the Practice of Medicine, Osteopathy, Podiatry, and Chiropractic (18 VAC 85-20-10 et.Seq.); and the Drug Laws for Practitioners.
- The physician within thirty days shall submit notification to all federal, state, and local agencies, and any hospital and/or medical staff with whom the physician is affiliated of her correct birth date.
- The physician shall submit a certified copy of her birth certificate to the Board.