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Showing posts with label False Medicare Billing. Show all posts
Showing posts with label False Medicare Billing. Show all posts

Tuesday, October 23, 2012

American Therapeutics' program director Abreu gets 108 months

 by Kevin Gale
South Florida Business Journal
Originally published October 15, 2012


Vanja Abreu, former program director at the mental health care company American Therapeutic Corporation (ATC), was sentenced Thursday to 108 months in prison for participating in the $205 million Medicare fraud scheme, a press release from the U.S. Attorney's office said.

Abreu, 49, of Pembroke Pines, worked at ATC centers in Boca Raton and Miami. In addition to her prison term, U.S. District Judge Patricia A. Seitz sentenced Abreu to three years of supervised release following her prison term and ordered her to pay $72.7 million in restitution, jointly and severally with co-defendants.

On June 1, after a seven-week trial, a federal jury in the Southern District of Florida found Abreu, who holds a doctorate degree, guilty of one count of conspiracy to commit health care fraud.

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Evidence at trial revealed that program directors, including Abreu, helped doctors at ATC sign patient files without reading the files or seeing the patients. Evidence further revealed that Abreu and others would assist the owners of ATC in fabricating doctor notes, therapist notes and other documents to make it falsely appear in ATC’s patient files that patients were qualified for this highly specialized treatment and that the patients were receiving the intensive, individualized treatment PHP is supposed to be.

The entire story is here.




Thursday, August 30, 2012

Psychologist pleads guilty to $1M fraud

Rhett E. McCarty admitted filing bogus Medicare, Medicaid claims since 2008

The Lebanon Daily Record
Originally published August 21, 2012

A psychologist who practiced in the Lebanon area pleaded guilty in federal court last week to engaging in a $1 million scheme to defraud Medicare and Medicaid.

Rhett E. McCarty, 67, of Lake Ozark, pleaded guilty before U.S. District Judge Howard F. Sachs to health care fraud and to forgery, according to a media release from David M. Ketchmark, acting U.S. Attorney for the Western District of Missouri.

McCarty is a licensed psychologist and private practitioner who provided psychotherapy services to recipients of both Medicare and Medicaid in their homes in the Lebanon area.

The entire story is here.

Saturday, August 11, 2012

N.C. psychologist admits to $63 million Medicare, Medicaid fraud

By Jaime L. Brockway
IFAwebnews.com
Originally published on July 24, 2012

An Asheville, N.C., psychologist pleaded guilty earlier this month in Miami district court to submitting more than $63 million in fraudulent claims to Medicare and Medicaid in Miami, Fla., and Hendersonville, N.C.

Serena Joslin, 31, admitted to participating in a fraud scheme operated through Health Care Solutions Network (HCSN), which operated partial hospitalization programs (PHPs), or intensive mental health treatments for severe mental illness, in Miami and Hendersonville.


Saturday, May 5, 2012

U.S. Charges 107 With Defrauding Medicare

By Louise Radnofsky
Wall Street Journal
Originally published on May 2, 2012

Federal officials said Wednesday they had charged 107 people across the country in recent days for allegedly running a string of unrelated Medicare fraud schemes involving a total of $452 million in false claims.

Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius said that charges were being brought against defendants in seven cities, including doctors and nurses, for seeking to defraud the federal health program for the elderly and disabled. At least 83 of the defendants were arrested Wednesday morning, officials said.

Among those arrested were seven people in Baton Rouge, La., who were accused of recruiting elderly, mentally ill and drug-addicted patients from nursing homes and homeless shelters.

The entire story is here.

Sunday, April 15, 2012

Tenet to pay almost $43 million to settle false claims

Reuters
Originally published April 10, 2012

Tenet Healthcare Corp has agreed to pay almost $43 million to settle allegations that it overbilled the federal Medicare healthcare program for treating patients at certain rehabilitation facilities, the Justice Department said on Tuesday.

The entire story is here.

Tuesday, March 13, 2012

Medicare Combats Fraud with Consumer Friendly Billing

By Susan Jaffe
Kaiser Health News in conjunction with The Washington Post
Originally published March 7, 2012

In the latest effort to enlist seniors in the fight against Medicare fraud, federal officials have overhauled Medicare billing statements to make it easier to find bogus charges without a magnifying glass.

The new, more consumer friendly format, which goes online Saturday on Medicare's secure website, www.mymedicare.gov, includes larger type and explanations of medical services in plain English. The revised paper version, which is mailed to seniors every three months, will be phased in early next year.

"You can make a difference!" the revamped statement says. "Last year Medicare saved taxpayers $4 billion - the largest sum ever reported in a single year thanks to people who reported suspicious activity to Medicare."

And for those who might need an incentive to scour their bills, the new statements promise a reward of up to $1,000 for a tip that leads to uncovering fraud. Although the bonus isn't new, there's no mention of it on current forms, which are sent to about 36 million beneficiaries in traditional Medicare.

"We approached this redesign from the standpoint of making it a more consumer-friendly document for beneficiaries and also a better fraud-fighting tool," said Erin Pressley, director of creative services for the Centers for Medicare and Medicaid Services. "If they are paying attention to these documents, they are going to be the best defense we have."

Friday, March 9, 2012

$375M health care scheme went unnoticed for years

By Norman Merchant
Associated Press
Published on March 1, 2012

DALLAS (AP) — The Texas doctor accused of "selling his signature" to process almost $375 million in false Medicare and Medicaid claims went unnoticed for half a decade by a fraud detection system that some critics say is broken.

Authorities say Jacques Roy and six others indicted for health care fraud certified 11,000 Medicare beneficiaries through more than 500 home health providers over five years. Those numbers would have made Roy's Medicare practice the busiest in the country. But an investigation into Roy and his business practices didn't begin until about a year ago, officials said.

The federal agency that administers Medicare has two sets of contractors: one to pay claims and another evaluating those claims for fraud. U.S. Health and Human Services investigators have found that health officials often have a hard time tracking the work of contractors that are supposed to detect Medicare fraud — estimated by some to reach $60 billion annually.

Federal officials who announced the indictment against Roy and six others in Dallas acknowledged the problems with the system. They contend they have improved data analysis and are working to move away from having to "pay and chase" offenders.

Others say Medicare is still very vulnerable to fraud.

"It's a trust-based system that is ripe for the picking by criminals," said Kirk Ogrosky, a Washington, D.C., attorney at the law firm Arnold & Porter and a former top health care prosecutor at the U.S. Department of Justice.

The entire story is here.

Monday, January 9, 2012

Lawsuit Accuses Company Of Fraudulently Cycling Patients Through Nursing Homes, Hospice Care

By Jordan Rau
Kaiser Health News Staff Writer
Originally published January 4, 2012

A national hospice company improperly cycled patients through nursing homes and hospice with a goal of making as much profit as possible from Medicare, according to a whistleblower lawsuit announced this week.

Federal attorneys also sued the hospice company, AseraCare, alleging it milked Medicare’s hospice benefit by pressuring its employees to enroll people into hospice who weren’t dying and resisted discharging them despite evidence they weren’t deteriorating. One hospice patient who should have been immobile from end-stage heart disease was healthy enough to go to his granddaughter’s graduation and a berry-picking excursion with a friend, the government charges.

For years, some critics of Medicare’s hospice benefit have said that the way the government pays providers gives them financial incentives to abuse the system. The suits against AseraCare, a Fort Smith, Ark.-based hospice company operating in 19 states, follow several other suits against big hospice companies but go further in their allegations that the company coordinated its use of nursing care and hospice care to maximize Medicare reimbursements.

The entire story is here.

Sunday, September 25, 2011

91 charged with Medicare fraud across U.S.

By Jerry Markon
The Washington Post
Published September 7, 2011

The Obama administration escalated its crackdown on health-care fraud Wednesday, announcing charges against 91 people in eight cities who are accused of bilking the Medicare system out of nearly $300 million and victimizing the elderly and disabled people who rely on the federal insurance program.

Among those charged in the coordinated series of arrests was a doctor in Detroit who allegedly billed Medicare for services provided to dead people and claimed that he performed psychotherapy treatments more than 24 hours a day. Other doctors, nurses and health-care company owners were charged in various schemes to get paid for services that were medically unnecessary or never provided, officials said.

“From Brooklyn to Miami to Los Angeles, the defendants allegedly treated the Medicare program like a personal piggy bank,’’ Lanny A. Breuer, assistant attorney general for the Justice Department’s criminal division, said at a news conference in Washington.

It was unclear whether lawyers had been appointed for the defendants, 70 of whom were charged in indictments unsealed this week. The other 21 were charged in recent weeks. More than 55 defendants had been arrested by Wednesday afternoon, in addition to others who turned themselves in to authorities.

The arrests, announced by Attorney General Eric H. Holder Jr. and Health and Human Services Secretary Kathleen Sebelius, marked the latest step in a campaign against fraud that the administration calls a key part of its health-care reform agenda. The health-care overhaul law, President Obama’s signature domestic initiative, is an issue in the presidential campaign, but few have questioned the need to crack down on fraud.

In May 2009, the administration launched the Health Care Fraud Prevention and Enforcement Action Team to seek out illicit billing practices. That team’s Medicare Fraud Strike Force carried out the raids in cities that also included Houston, Baton Rouge, Dallas and Chicago.

In Miami, 45 defendants — including a doctor and a nurse — are accused of participating in $159 million worth of schemes to submit false Medicare billings for home health care and other services. Holder said the victims included “some of the most vulnerable among us — including seniors suffering from dementia and Alzheimer’s disease.’’

Officials said the crackdown will continue. “The health-care system is part of our nation’s infrastructure, and we must do everything in our power to protect the integrity of Medicare,” said FBI Executive Assistant Director Shawn Henry.

The entire story can be read here.