Articles Posted in Medicare Fraud

Your day started out just like every other day.  You go through your typical daily routine.  Over a cup of coffee, you check the headlines for the latest news.  A plane has crashed leaving no survivors while expectant loved ones morn them when they learn of the tragedy.  The president tweeted something outlandish once again that makes you scratch your head that has drawn him yet another heavy dose of criticism.  Some famous Hollywood actor or producer has been accused of groping an up and coming starlet who is suing him for a small fortune.  A priest has been excommunicated after years of sexual abuse that the diocese claimed to not know about and tried to sweep it under the carpet.  A crazed husband commits a murder-suicide after being served with divorce papers.   You read through your email and reply as necessary.

Target-letter-2-300x188As the day rolls on, things are pretty predicable.  The mail gets delivered.  You throw away the junk mail, then you see it.  Your heart skips a beat.  It’s a letter from the local U.S. Attorney’s Office.  It’s addressed to you.  You start to shake and your hands tremble as you tear open the envelope and begin to read.

Dear Mr. / Ms. So & So:

BigStock_KickBackTypically, when I meet with clients for the first time, it never ceases to amaze me that they have little or no idea what constitutes Medicare fraud is and didn’t know they couldn’t be doing the things they were doing.  So, I decided to write this post to give a primer to explain: what is Medicare Fraud?

For those who are working in the medical field, whether they are doctors, corporate owners of medical practices, pharmacists, pharmacy owners, lab owners, durable medical equipment business owners, just to name a few, it can’t be overemphasized that it is essential to be familiar with the basics of Medicare fraud.

With this in mind, I want to make sure you are informed about how someone can get themselves in trouble. In general, Medicare fraud refers to submitting a false claim in a Medicare beneficiary’s name to a governmental sponsored health care program for reimbursement.

Corrupt-doctorIn a nutshell, the federal Anti-Kickback Statute and Stark Law make it a crime with serious penalties for providers of medical services to pay or accept any form of remuneration such as kickbacks or anything of value in exchange for receiving referrals of patients who obtain medical treatment paid by government healthcare programs including Medicare and Medicaid, and from entering into certain kinds of financial relationships.

The Anti-Kickback Statute and the Stark Law are designed to keep medical treatment decisions independent from any influence of possible financial gain. The Anti-Kickback Law and the laws prohibiting other unlawful financial arrangements are designed to prevent healthcare providers from referring patients for healthcare services that are not medically necessary.

The Department of Justice has declared that, “[p]atients are entitled to be sure that the care they receive is based on their actual medical needs rather than the financial interests of their physician.”

Housecalls.jpgDETROIT, MI (March 5, 2014) – Jose Mercado-Francis, 60, a former Detroit-area physician pleaded guilty today in the U.S. District for the Eastern District of Michigan to one count of conspiracy to commit health care fraud in violation of 1371 for his role in an $11.5 million health care fraud scheme.

Even though Mercado-Francis’ medical license had been revoked and he was not licensed to practice medicine in Michigan, that didn’t stop him. Mercado-Francis admitted in his plea agreement that, from September 2009 and through February 2012, he held himself out to the public as a licensed medical doctor and claimed to provide physician home health services to Medicare beneficiaries.

Court documents allege that Mercado-Francis prepared medical documentation that licensed physicians signed as if they had actually provided services to Medicare beneficiaries, when, in fact, no such services were provided. The phony health services were then submitted to Medicare as if licensed physicians had performed them.

On December 16, 2014, a Houston psychiatrist was arrested on charges related to her alleged participation in a $158 million Medicare fraud scheme involving false claims for mental health treatment.

Sharon Iglehart, 56, of Houston, was charged in the U.S. District Court for the Southern District of Texas by indictment with one count of conspiracy to commit health care fraud and four counts of health care fraud. According to preliminary calculations, the United States Sentencing Guidelines call for a sentence that is more than twice the maximum penalty of 10 years in prison that can be imposed on each count. Without taking Dr. Iglehart’s role in the conspiracy into consideration, the guidelines call for a sentence in the range of 235-293 months.

According to the indictment, Iglehart is alleged to have participated in a scheme to defraud Medicare that started in 2005 and continued until May 2012. Iglehart is accused of having caused the submission of false and fraudulent claims for partial hospitalization program (PHP) services to Medicare through Houston’s Riverside General Hospital. A PHP is a form of intensive outpatient treatment for severe mental illness.

handcuffs-and-calculator-on-headlines-about-white-collar-crime.jpgCHICAGO (August 27) — DIKE AJIRI, 42, of Wilmette, CEO of Mobile Doctors, a Chicago-based business which manages physicians who make house calls in six states, and BANIO KOROMA, 63, of Tinley Park, a physician one of its physicians in Chicago were arrested on Medicare fraud charges. The charges allege a scheme to fraudulently increase (also known as “upcoding”) Medicare bills for in-home patient visits that Mobile Doctors falsely claimed were more extensive and lasted longer than they did. The charges also allege that Mobile Doctors’ physicians falsely certified that patients were confined to their homes, paving the way for home health care agencies to seek Medicare reimbursement for fees for additional services for patients who were not qualified to receive them.
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doc-thumbWASHINGTON, D.C. (August 15) – On August 14, 2013, a Detroit-area physical therapist who was also an owner of a home health agency entered a guilty plea to one count of conspiracy to commit health care fraud in the U.S. District Court for the Eastern District of Michigan regarding his role in a $22 million home health care fraud scheme. Bhagat faces a maximum penalty of 10 years in prison and a $250,000 fine. Sentencing is scheduled for November 12, 2013.

According to information contained in plea documents, Bhagat admitted that over about a year and a half period beginning May 2009, he conspired with others to commit health care fraud through billing Medicare for home health care services that were either not actually rendered or not medically necessary.

Bhagat admitted that his co-conspirators paid kickbacks to patient recruiters to obtain the information of Medicare beneficiaries, which the co-conspirators then used to bill Medicare. Bhagat and his cohorts then created phony therapy files to falsely document physical therapy services were provided to Medicare beneficiaries, when in fact no such services had ever been provided and if provided were not medically necessary in the first place.

sebelius-holder-announcementWASHINGTON, D.C. (May 14,2013) A nation-wide takedown by the Medicare Fraud Strike resulted in charges being filed against 89 health care providers including doctors, nurses and other licensed medical professionals, for committing Medicare fraud to the tune of approximately $223 million in false claims billings.

In Miami, a total of 25 people were charged for participating in various fraud schemes to submit false billings for home health care, mental health services, occupational and physical therapy, DME and HIV infusion services. Among those arrested were two nurses, a paramedic and a radiographer were charged with crimes for involving a total of $44 million.

In one case, involving Trust Care Health Services, three people – including Roberto Marrero, a Miami actor and local cable TV station owner, were charged with health care fraud and violations of the anti-kick back statute for their involvement in a $20 million home health fraud scheme concerning the treatment of diabetic patients. Court documents accuse the defendants of bribing Medicare beneficiaries to turn over their Medicare information, which was used to bill for services that were not rendered or were medically unnecessary.

doc-thumbHOUSTON (March 13) – A Texas doctor who was convicted of conspiracy to commit health care fraud and six counts of false statements relating to health care matters was sentenced today to serve 63 months behind bars.

Ben Harris Echols, 63, of Houston, was convicted late last year of conspiring to commit health care fraud by falsifying plans of care for Medicare beneficiaries, including patients whom he did not treat, as part of a $17.3 million Medicare fraud scheme. Upon completion of his prison term, Echols was ordered to serve three years of supervised release and pay restitution in the amount of $2,918,830.

According to evidence presented at trial, Echols signed plans of care for Medicare beneficiaries who were not under his care and about whose conditions he had no knowledge. In many instances, Echols signed plans of care even though other doctors were listed as the attending physician on the documents.

sebelius-holder-announcementWASHINGTON, D.C. (October 4,2012) Today, U.S. Attorney General Eric Holder and U.S. Department of Health and Human Services Secretary Kathleen Sebelius announced at a joint press conference that Medicare Fraud Strike Force operations conducted one of the largest health care fraud takedowns in history.

Charges have been brought in seven cities from Brooklyn to Los Angeles against 91 individuals – including doctors, nurses, and other licensed medical professionals – for their alleged participation in fraud schemes involving nearly $430 million in false billings.

Charges include health care fraud, conspiracy to commit health care fraud, wire fraud, violations of the anti-kickback statutes, aggravated identity theft, and money laundering charges are based on a variety of alleged activities involving treatments and services that were medically unnecessary or never actually rendered.

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