Medicaid Fraud

Judge Sentences Three Family Members Convicted of Medicare Fraud

October 31, 2011 | Robert David Malove

handcuffs-and-calculator-on-headlines-about-white-collar-crime.jpg TAMPA (October 21) Last week, Gregory Bane, the Vice President for Operations and I.T. manager of Bane Medical Services and Oxygen and Respiratory Therapy was sentenced to three years in federal prison for conspiracy to commit health care fraud, health care fraud, and submitting false claims. Tracy Bane, the billing supervisor, was sentenced to six months in federal prison, and 18 months of house arrest for conspiracy to commit health care fraud, health care fraud and submitting false claims. In September, Ben Bane was sentenced to twelve years and six months in federal prison for conspiracy to commit health care fraud, health care fraud, and submitting false claims.

Late last year, the Banes a federal jury returned a guilty verdict for conspiracy to commit health care fraud, health care fraud and submitting false claims. During the trial, testimony and evidence presented showed the Banes knowingly violated Medicare rules prohibiting durable medical equipment (DME) companies who sell equipment from performing their own qualification testing.

Over the course of four years, Bane Medical Services and Oxygen and Respiratory Therapy, Inc., performed incorrect tests, deliberately misled doctors about it, faked test results to make it look like patients qualified for Medicare-reimbursed oxygen even though they did not, and forged doctors signatures on Certificates of Medical Necessity.

BREAKING NEWS: Feds Charge Dozens in Mental Health Medicare Fraud

September 6, 2011 | Robert David Malove

MIAMI, FL (September 6, 2011) FBI Special Agents, U.S. Department of Heath and Human Services (HHS) Office of the Inspector General agents fanned and other law enforcement personnel who are members of the U.S. Department of Justice Medicare Fraud Strike Force set out at dawn this morning across South Florida and arrested dozens of suspects charged with stealing Medicare of hundreds of millions fraudulent mental health therapy and other types of healthcare.

Among those arrested are: mental health clinic owners, healthcare employees, patient recruiters and assisted living facility owners.

Stand by for further info.

MASSACHUSETTS AG RECOVERS $69M IN MEDICAID FRAUD

August 19, 2011 | Robert David Malove

BOSTON, MASSACHUSETTS (AUGUST 29, 2011) – Massachusetts State Attorney General Martha Coakley’s office released information that it had recovered $69 million in Medicaid fraud during the fiscal year 2011. The previous record was $14 million in 2009.
Since she took office in 2007, AG Coakley’s office has added $200 million in Medicaid fraud back to the state fund’s coffers. The $69 million figure alone represents more than the total previously collected in the ten years prior to Coakley’s tenure. For every dollar the AG’s Medicaid Fraud Division has allocated to its budget, $18 is recovered to the taxpayer.
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HOUSTON NURSING HOME ADMINISTRATOR ARRESTED

August 16, 2011 | Robert David Malove

HOUSTON, TEXAS (AUGUST 16, 2011) – A Houston area nursing home administrator was arrested in connection with an indictment handed down by a grand jury in which he was charged with conspiracy, health care fraud and violations of the anti-kickback statute.
Kelvin Washington, 47, ran a Sugar land area nursing home and was purported to have received payments for referring dialysis patients to a specific ambulance transport service between 2003 and 2007. Washington also conspired to have doctors sign transport orders for dialysis patients. The patients whose names he used, however, were never admitted to that nursing home. By the time investigators compiled their case, Washington had helped amass over $1 million in false claims to Medicare. For his part in the scheme, Washington received over $20,000.
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INSPECTOR GENERAL FINDS MOST POWER WHEELCHAIRS UNNECESSARY

August 12, 2011 | Robert David Malove

WASHINGTON (AUGUST 12, 2011) – The Office of the Inspector General of the Department of Health and Human Services says more than 60 percent of all power wheelchairs, which are usually covered 100 percent by Medicare or private insurance, are not necessary for patients. The high cost of these chairs make them an attractive sales product for slick salesmen eager to make a buck.
Past investigations show that Medicare has paid close to four times the average $1,048 cost, making Medicare responsible for more than $4,000 for each chair. In many cases, the chairs won’t work in the patient’s home because doorways are too narrow or there is simply not enough room in the house to maneuver the chair. In Marvin Rosen’s Coral Springs home it’s become something he sits in occasionally to watch television because the chair isn’t supposed to be used outside, and his home is too small to use it inside. The company who provided him with the chair failed to measure his home, which is a requirement before a patient can receive one.
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FBI SEEKING PUBLIC’S HELP IN TARGETING HEALTH CARE FRAUD

August 2, 2011 | Robert David Malove

NEWARK, NEW JERSEY (AUGUST 2, 2011) – The FBI wants the public’s help in preventing health care fraud and they’re putting up advertisements in malls and on highways to bring attention to their campaign. Digital ads went up in malls in Paramus, Wayne, Hackensack and Atlantic City, as well as on the Jersey Turnpike near the Lincoln Tunnel and several major highway systems.

The Newark office of the FBI is credited with the idea for the program. For the next two months that the ads are up, the Bureau hopes to see an increase in the number of tips reporting health care fraud. If the New Jersey campaign is successful, the Bureau will turn it into a national program with the help of Clear Channel, who also assists on the “Most Wanted” digital billboards.

Health care fraud costs the American taxpayer approximately $60 billion a year, and in New Jersey the loss was $8 million in 2010. As the number of reported health care fraud cases has fallen off in recent years, the FBI hopes to educate the public on how much they’re losing by not reporting fraud. Agent Sean Keyes says “all of the best criminal investigations are human-source driven.”

NEW JERSEY NEUROLOGIST ON SUSPENDED LICENSE CHARGED WITH MEDICAID FRAUD

July 28, 2011 | Robert David Malove

JERSEY CITY, NEW JERSEY (JULY 28, 2011) – Arrested for a second time in connection with fraud, Dr. Madgy Elamir was charged with health care claims fraud, Medicaid fraud and practicing medicine without a license. Elamir continued to write prescriptions despite his license having been suspended in connection with a previous arrest.

The defendant also has a trial date scheduled in September in an earlier case for his alleged role in a major narcotics trafficking and Medicaid fraud ring with connections in Hudson, Bergen, Ocean, Morris and Monmouth counties. Elamir allegedly wrote prescriptions for medically unnecessary prescriptions and illegally distributed the controlled drugs, Xanex and Percocet, in exchange for cash.

Elamir’s bail on the new charges has been set at $1 million.

MEDICARE FRAUD PREVENTION SYSTEMS INADEQUATE CLAIMS ACCOUNTABILITY OFFICE

July 26, 2011 | Robert David Malove

MIAMI, FLORIDA (JULY 26, 2011) – The Government Accountability Office recently issued a report stating the federal government’s analysis systems for Medicare and Medicaid are “inadequate and underused.” The report further reveals that the systems don’t even analyze Medicaid data, and of the 639 analysts targeted for training with the system, only 41 have received it. The technology slated to save $21 million in Medicare and Medicaid lacks the formal planning for implementation, even though $150 million has been invested in the technology.
When the new system went live in 2009, it was intended for use by the Center for Medicare and Medicaid Services (CMS), contractors, law enforcement and state agencies, with access to the information shared across all states. Because funding for the software was delayed, the rollout date has been pushed to November 2011.
In the meantime, CMS has another fraud prevention technology program in the works, similar to the system that screens for credit card fraud. That contract came with a $77 million price tag. With approximately 4.5 million claims processed on a daily basis, rollout of these programs can’t come fast enough for the taxpayer’s wallet.

HOUSTON HEALTH CARE COMPANY OWNER PLEADS GUILTY TO $1.3 MILLION MEDICARE FRAUD

July 5, 2011 | Robert David Malove

handcuffs-and-calculator-on-headlines-about-white-collar-crime.jpg HOUSTON, TEXAS – The Departments of Justice and Health and Human Services announced that Ekpedeme Obot, 34, pled guilty to health care fraud and making false statements relating to health care matters in a $1.3 million Medicare fraud scheme. Obot was owner and operator of Praise DME, a durable medical equipment company that collected $945,637 in false claims.
From March 2007 to August 2008, Obot submitted claims for durable medical equipment, including orthotic devices such as braces, and accessories such as heating pads, for the treatment of arthritis that were not medically necessary. In addition to the false claims, Obot failed to provide information about his prior conviction on felony theft from 2007, which is required in the supplemental Medicare Enrollment Application. He reported only that he had been under a recoupment action by Texas Medicaid and had entered into a payment arrangement.
Sentencing is scheduled for October 12, 2011. For the count of health care fraud, Obot faces a maximum penalty of 10 years in prison and five years on the false statements charge.

MICHIGAN COUPLE CHARGED IN HEALTH CARE FRAUD

June 30, 2011 | Robert David Malove

TROY, MICHIGAN – Charged with conspiracy to commit health care fraud and money laundering, a Michigan couple, Surya and Srinivas Nallani, ran a $9 million physicians home visit business.
From 2005 until February 2010, the company, Allied Geriatric Services, submitted fraudulent bills through its billing manager, Srinivas Nallani. His wife, Dr. Surya Nallani billed for home visits for times while she was out of the country or for time when the distance between two locations would have made same-day travel impossible.
The maximum sentence the charges carry is 10 years in prison and a $250,000 fine, however, attorneys for the U.S. are seeking forfeiture of the Nallanis’ assets in the amount of $825,000 and two of their vehicles.