Cutting Edge Medicare Fraud

HBOC.jpg Florida, New York and California are generally on the cutting edge of Medicare fraud, and many hours of law enforcement time is taken to uncover the next wave of perceived schemes. However, fresh from Georgia: hyperbaric oxygen therapy fraud.
A clinic owner in Georgia plead guilty to receiving over $1,000,0000 in reimbursement for treatment, “Hyperbaric chambers have a number of legitimate medical uses, as varied as helping burn victims and even scuba divers in their recovery. This defendant, however, turned a hyperbaric chamber into a means of generating over a million dollars in fraudulent claims…” said United States Attorney David E. Nahmias. To read more about this, click here
While it appears on the surface that fraudulent claims, particularly arising out of a single clinic would be quickly discovered and it would also seem that there are not enough burn victims or senior citizen scuba divers with the bends to make such treatment viable in the Medicare context, those are not the only reimbursable services. There is a national coverage determination (NCD) NCD 20.29 that permits hyperbaric oxygen therapy (HBOT) for several uses, particularly diabetic patients who have diabetic wounds of the lower extremities after there are no measurable signs of healing for at least 30 days of treatment with standard wound therapy and must be used in addition to standard wound care. There is also a Florida local coverage determination (LCD); LCD L28887. Click here for more.
You can read the USAO Press Release about the case by clicking here.