Articles Posted in Medicare

handcuffs-and-calculator-on-headlines-about-white-collar-crime.jpgWASHINGTON – A Detroit-area patient recruiter pleaded guilty today for his participation in a Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).
Daron Elder, 28, of Southfield, Mich., pleaded guilty in the Eastern District of Michigan to one count of conspiracy to commit health care fraud. At sentencing, he faces a maximum penalty of 10 years in prison and a $250,000 fine. However, the advisory sentencing guidelines call for a term of imprisonment of 30-37 months, restitution in the amount of almost $3 million, plus a $1 million fine.
According to the  plea documents, Elder was a patient recruiter for a medical clinic in the Detroit area, Blessed Medical Clinic. Elder paid indigent Medicare beneficiaries cash kickbacks to receive diagnostic tests that he knew were medically unnecessary. In return for the cash kickbacks, the Medicare beneficiaries allowed their identification to be used in the submission of fraudulent claims. The government will argue at sentencing that Elder’s conduct caused the submission of approximately $2.5 million dollars in fraudulent claims to Medicare.

infusion.1.jpgDETROIT, MI (May 6, 2011) – Two owners of a Dearborn HIV-infusion clinic were convicted of conspiracy to commit health care fraud, conspiracy to pay health care kickbacks, health care fraud and conspiracy to commit money laundering. Leonio Alayone, the person who helped them launder their financial gains, was convicted of conspiracy to commit money laundering and money laundering.

According to the superseding indictment, the two owners and brothers, Martin and Joaquin Tasis, paid kickbacks to patients when the brothers used the patients’ Medicare accounts to bill for services never performed. Evidence showed that the Dearborn Rehabilitation and Medical Center was specifically established for the purpose of defrauding Medicare. From 2005 to 2007, Medicare was billed $9.1 million by the clinic for medically unnecessary treatments or services that were never performed.

Initially, the clinic was located in South Florida. The brothers later moved the clinic to Michigan when law enforcement became suspicious of possible fraudulent practices. So far 12 individuals involved in the case have been convicted for their part in the fraud; two others are awaiting trial.

gavel%20and%20stethescope.jpgAs reported previously here, a central feature of the Obama administration’s health care reform has been the HEAT (Health Care Fraud Prevention and Enforcement Action Team) initiative is the use of Strike Force teams. Strike Forces are multi-agency units of Federal and State law enforcement personnel designed to identify, investigate, and prosecute Medicare fraud. Strike Forces are supported by a CMS data analysis team and CMS program experts.

Since May 2009, this Administration has expanded Strike Force cities from Miami and Los Angeles, when Strike Force teams were launched in Houston and Detroit in May 2009 and in Brooklyn, Baton Rouge, and Tampa in December 2009. (To read more, click: here).

Building on the momentum started last May, U.S. Department of Health and Human Services Deputy Secretary William Corr and U.S. Department of Justice Acting Deputy Attorney General Gary Grindler, testified earlier this month before the United States House of Representatives Subcommittee on Labor, Health and Human Services, Education, and Related Agencies Committee on Appropriations and stated that the entire $250 million increase in the President’s Budget advances the goals of the HEAT initiative.

prison.jpgMIAMI, FL (September 22, 2009) Today the Miami Herald reported that “A fugitive who claimed to be Mexican but was betrayed by his Cuban accent — which led to his arrest in Spain — was sentenced to eight years’ imprisonment Monday in Miami federal court on U.S. Medicare fraud charges. For more: Click here

system_error.jpgOne study by CMS found that up to 70% of payments for some medical equipment should not have been due to a failure to document the medical necessity for the equipment provided under CMS guidelines. In 2008, the errors resulted in $2.8 billion. A representative of CMS indicated that the numbers were not actual fraud, but the error rates made fraud more likely. A new program is of regional bidding for DME suppliers is expected to begin in 2010.
To read more, click here.