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Response from Office of Stratford Doctor Accused of Fraudulent Billing

The following statement comes from the office of Dr. James P. Ralabate, who entered into a civil agreement Thursday after allegations surfaced that he and his company engaged in fraudulent billing at several nursing homes in Connecticut.

See related article: Stratford Doctor to Pay $700K for Alleged Nursing Home Scheme

Dr. Ralabate has an exemplary record of providing excellent care for all of his patients. He has never provided inappropriate or insufficient services. Because Dr. Ralabate always takes his patients' welfare as his primary concern, he believes he has greatly reduced his patients' suffering as well as hospital readmissions, saving money for his patients and the Government. Because of his excellent service, the skilled nursing facility's CMS rating under his care went from a 2 to a 5, which is the maximum rating such a facility can obtain.

Prior detailed audits by CMS proved that only 2 out of 54 procedures/services studied were coded higher than the documentation supported and only 1 was thought to be for more services than necessary, while 14 were actually under-coded. Even though he provided more services than his peers, 98.2 percent of the services studied extensively were found to be medically necessary. This prior audit actually resulted in increased payments to Dr. Ralabate.

Dr. Ralabate had an excellent administrative record. It was only when he later learned that the excellent level of care he provides to all his patients was found in a later audit to be beyond what Medicare pays for that he chose to settle the case -- rather than take time away from his patients and pay legal bills for a trial. This was a hard decision, because he learned during the Government's review that even investigators said they would love to have their parents receive the better than the customary care he provides.

The Government alleged that Dr. Ralabate billed for nursing home services while patients were in the hospital. Dr. Ralabate did in fact visit and provide his services to his nursing home patients in the hospital as part of his commitment to excellent and continuous care for his nursing home patients and he never billed for services that were not provided. The financial settlement was only based upon the Government's belief that some health services were miscoded, or provided more care than Medicare would pay for. He chose to hire billing and coding experts to prevent any risk of noncompliance and assure no future questions, and continue his exemplary care for his patients.

Mike Leone February 05, 2013 at 02:20 PM
All too often in business we are faced with settling disputes because it is less costly in terms of dollars, emotional stress, and intellectual capital. Legal fees alone for the doctor in a case like this have to be an enormous burden. It's not easy to fight this federal government. One of the risks in taking such a course of action is that the ignorant and uninformed in society read guilt into the situation when none is admitted or present. Anonymous posts by cowards are simply best ignored.
Yanks5881 February 05, 2013 at 02:33 PM
Having worked in the medical field for over 20 years, physicians are extremely educated in clinical coding for all matters. They are fully aware of what codes need to be justified by what means. Specifically, I am sure Dr. Ralabate was fully aware of how he coded his visits. Each code carries specific guidelines and each have to be met in order to charge that particular dollar amount. He may be a wonderful person, doctor, friend, but unfortunately he has been caught overbilling for his services. This is a long process, audits take years to complete. I doubt, with all the evidence Medicare had against him, that a trial would have been successful for him. You don't settle for an amount of $700,000 if you are NOT GUILTY. Any person with such ethics, I am sure, would not just settle but instead fight the battle to prove his innocence.
Joan Bershefsky February 06, 2013 at 03:18 PM
How quick people are to judge. Unless you have walked in this man's shoes,then you have no right to say that he is guilty. This whole situation has been a witch hunt because a doctor gave extra care to his patients. He had every right to be compensated. Those of you who make cynical and negative assertions might want to know the person involved before you make such cruel comments. Judge not lest ye be judged. What a waste of our tax dollars to spend so much time investigating a good decent man. Let he who is without sin cast the first stone.
pebcrn February 08, 2013 at 12:37 AM
PCRN. I AGREE THAT THIS IS A SLANDERIOUS AND A WITCHHUNT OF A EXCELLANT MD AND A GOOD, KIND AND TOTALLY PROFESSIONAL PERSON.YES IT WAS A BILLING CODE ISSUE AND IT WAS FOUND, BUT THE MAN RECTIFIED THIS ISSUE AND WILL IN THE FUTURE HAVE HIS CODE PROFESSIONALS OVERSEE THIS PART OF HIS BILLING,BUT TRUST ME WHEN I SAY THIS .YOU CAN NOT PAY ENOUGH FOR WHAT THIS MAN GIVES IN HIS CARE .THE GOVT SHOULD PAY HIM DOUBLE.I'VE KNOWN THIS MD FOR MANY YEARS IN THE NURSING HOME FIELD AND IT WAS NOT INTENTIONAL WHAT HAPPENED. WHY SHOULD HE WASTE THE TIME FOR A TRIAL, HIS PTS ,FAMILY AND THE COMMUNITY NEED HIM.MR FEIN SHOULD GO AFTER THE A FEW OTHER MDS ON STAFF WHO TELL THE STAFF AT THE NURSING HOMES THEY ONLY MAKE 18 DOLLARS A VISIT AND 150 FOR AN ADMISSION TO THE NURSING HOME.THEY COME IN ONCE AND THEN ALMOST FORGET THE PT IS THERE.THIS IS A FACT AS I HAVE WORKED IN A LOCAL FACILITY FOR OVER 25 YEARS.THE APRNS AND NURSES DO ALL THE WORK FOR THESE OTHER MDS.DR RALABATE HAS NEVER SAID THAT AND GOES ABOVE AND BEYOND IN HIS CARE AND INTEREST FOR HIS PTS.YOU DO ,MR BAGLEY OWE HIM AN APOLOGY AS WELL AS MR FEIN AND THE GOVT.
Melissa Whitaker March 12, 2013 at 10:50 PM
Dr. Ralabate has always been a caring, compassionate doctor. I'm proud to say that I worked for him for a short time. He always took time with his patients, LISTENED to them (that is huge!) and was and is 100% professional. When my husband was a patient at a local ECF, Dr. Ralabate visited him, went over his meds, answered any questions and concerns that my husband had and took excellent care of him. I do not believe the allegations against him. He is an excellent doctor , a God-fearing man, and one one the best family men I know. May God bless you, Doc!

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