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Showing posts with label Medicare Fraud. Show all posts
Showing posts with label Medicare Fraud. Show all posts

Sunday, September 8, 2019

DC Physician Indicted for Almost $13M in Medicare Fraud

Ken Terry
MedScape.com
Originally posted August 9, 2019

A physician who has a practice in the District of Columbia has been charged with participation in an alleged $12.7 million healthcare fraud scheme that involved submitting false claims to Medicare for complicated procedures that were never performed, according to a Department of Justice (DOJ) news release.

In an indictment filed July 30 in the District of Columbia, physiatrist Frederick Gooding, MD, aged 68, of Wilmington, Delaware, was charged with 11 counts of healthcare fraud. He was arrested on August 1.

According to the indictment, from January 2015 to August 2018, Gooding participated in a healthcare fraud scheme in which he submitted Medicare claims for injections and aspirations that were not medically necessary, not provided, or both.

Gooding allegedly knew that the injections were not provided. To disguise his scheme, he allegedly falsified medical documents to make it appear as if the purported medical services billed to Medicare were medically necessary.

The info  is here.

Friday, May 3, 2019

Fla. healthcare executive found guilty in $1B Medicare fraud case

Associated Press 
Modern Healthcare
Originally published April 5, 2019

Florida healthcare executive Philip Esformes was found guilty Friday of paying and receiving kickbacks and other charges as part of the biggest Medicare fraud case in U.S. history.

During the seven-week trial in federal court in Miami, prosecutors called Esformes a trickster and mastermind of a scheme paying bribes and kickbacks to doctors to refer patients to his nursing home network from 2009 to 2016. The fraud also included paying off a regulator to learn when inspectors would make surprise visits to his facilities, or if patients had made complaints.

Esformes owns dozens of Miami-Dade nursing facilities as well as homes in Miami, Los Angeles and Chicago.

The info is here.

Tuesday, November 17, 2015

Two Psychologists Charged in $25.2 Million Fraud Scheme Involving Psychological Testing in Gulf Coast States

FBI Press Release
Originally released October 22, 2015

Two clinical psychologists were charged today with participating in a $25 million Medicare fraud scheme involving psychological testing in nursing homes in Gulf Coast states.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Kenneth A. Polite of the Eastern District of Louisiana, Special Agent in Charge Michael J. Anderson of the FBI’s New Orleans Field Office and Special Agent in Charge C.J. Porter of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Dallas Regional Office made the announcement.

Beverly Stubblefield, Ph.D., 62, of Slidell, Louisiana, and John Teal, Ph.D., 46, of Jackson, Mississippi, were charged by a superseding indictment with conspiracy to commit health care fraud and conspiracy to make false statements related to health care matters. Two other defendants, Rodney Hesson, Psy.D., 46, and Gertrude Parker, 62, both of Slidell, were charged in the initial indictment returned in June 2015 in connection with a large-scale Medicare Fraud takedown, and were also charged in today’s superseding indictment.

According to the superseding indictment, Hesson and Parker owned and controlled Nursing Home Psychological Service (NHPS) and Psychological Care Services (PCS), each of which operated in Louisiana, Mississippi, Florida and Alabama. The superseding indictment alleges that NHPS and PCS contracted with nursing homes in these states to allow NHPS and PCS clinical psychologists, including Stubblefield, Teal and Hesson, to administer to nursing home residents psychological tests and related services that were not necessary and, in some instances, never provided.

According to the superseding indictment, between 2009 and 2015, NHPS and PCS submitted more than $25.2 million in claims to Medicare. Medicare paid approximately $17 million on those claims.

The entire pressor is here.

Thursday, July 11, 2013

Medicare fraud outrunning enforcement efforts

By Fred Shulte
The Center for Public Integrity
Originally published on July 1, 2013

Citing massive budget and staff cuts, federal officials are set to scale back or drop a host of investigations into Medicare and Medicaid fraud and abuse — even though cracking down on government waste and cutting health care costs have been top priorities for the Obama administration.

The Department of Health and Human Services Office of Inspector General is set to lose a total of 400 staffers that are deployed nationwide as a primary defense against health care fraud and abuse. Though agency officials have yet to decide which investigations will be shelved as staff dwindles, the existing staff is already stretched so thin that the agency has failed to act on 1,200 complaints over the past year alleging wrongdoing — and expects that number to rise. The OIG began shedding staff at the beginning of the year.

The budget crunch surfaced during questioning at a June 24 hearing of the Senate Committee on Homeland Security and Governmental Affairs. The hearing was called to examine prescription drug abuse in Medicare.

Gary Cantrell, Deputy Inspector General for the OIG Office of Investigations, said at the hearing that his unit “is shrinking” even as the federal Medicare and Medicaid programs grow in size and complexity. “We’re set to lose roughly 400 bodies out of a total of 1,800 at our peak in 2012. That’s really limiting our ability to expand our oversight in some of these areas,” he said.

Stuart Wright, Deputy Inspector General for the OIG Office of Evaluations and Inspections, added that 200 of those staffers will have departed by the end of this year and 200 more are out the door by the end of 2015.

The entire story is here.

Thursday, May 23, 2013

Largest US Hospice Company Sued for Medicare Fraud

By Kelli Kennedy
The Associated Press/ABC News
Originally posted May 9, 2013

The Department of Justice is suing the hospice company founded by Florida's Senate president, accusing it of submitting tens of millions of dollars in fraudulent Medicare claims for more than a decade, including while Don Gaetz was vice chairman of the board.

Vitas Hospice and Vitas Healthcare submitted claims for emergency services for patients that weren't needed, weren't provided, or were provided to patients who weren't eligible under Medicare requirements, according to the DOJ. The companies set goals for the number of crisis-care days to be billed and pressured their employees to submit more claims so it would get more revenue, the lawsuit said. The agency said Medicare payments for crisis care can be hundreds of dollars greater than typical hospice care payments.

Vitas is the largest U.S. hospice care chain, and its parent company Chemed Corp. said the claims go back to 2002, two years before it acquired the company.

The entire article is here.

Doctors and nurses among nearly 100 charged in $223 million Medicare fraud busts in 8 cities

By Associated Press
Originally published May 14, 2013

Nearly 100 people, including 14 doctors and nurses, were charged for their roles in separate Medicare scams that collectively billed the taxpayer-funded program for roughly $223 million in bogus charges in a massive bust spanning eight cities, federal authorities said Tuesday.

It was the latest in a string of similar announcements by Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder as federal authorities crack down on fraud that’s believed to cost the program between $60 billion and $90 billion each year. Stopping Medicare’s budget from hemorrhaging that money will be key to paying for President Barack Obama’s health care overhaul. Sebelius and Holder partnered in 2009 to increase enforcement by allocating more money and staff and creating strike forces in fraud hot spots around the country.

The entire story is here.

Wednesday, December 26, 2012

New Medicare fraud detection system saves $115 million

By By KELLI KENNEDY
Associated Press
Originally published December 15, 2012


A highly touted new technology system designed to stop fraudulent Medicare payments before they are paid has saved about $115 million and spurred more than 500 investigations since it was launched in the summer of 2011, according to a report released Friday.

Federal health officials said the projected savings are much higher. The savings so far, however, are minuscule compared with the estimated $60 billion lost each year to Medicare fraud. With the Obama administration and Congress desperately looking for savings to avoid a budget meltdown, denting Medicare fraud has the potential to save billions of dollars annually.

However, the Department of Health and Human Services' inspector general noted the report had some inconsistencies in its data and questioned the methodology for calculating some of the figures.

"In these cases, we could not determine the accuracy of the department's information, which impeded our ability to quantify the amount of the inaccuracies noted in this report," the inspector general's office said in a review of the report. Officials in the office said regardless of the glitches, they believe the new fraud system is a useful anti-fraud, too.

The $77 million technology system fights fraud in much the way credit card companies scan charges and can freeze accounts. It saved $32 million by kicking providers out of the program or refusing to pay suspicious claims. The report from the Centers for Medicare and Medicaid Services, obtained by The Associated Press, was unclear on how many actual providers were suspended or revoked from Medicare.

The entire story is here.

Thursday, December 13, 2012

Justice Dept. recovers record $5 billion under False Claims Act

By Peter Finn
The Washington Post
Originally published: December 4, 2012


The Justice Department’s civil division recovered a record $5 billion in the past fiscal year from companies that defrauded taxpayers, with much of the abuse occurring in the health-care and mortgage industries.

The department pursued settlements and judgments under the False Claims Act, which Acting Associate Attorney General Tony West described Tuesday as “quite simply, the most powerful tool we have to deter and redress fraud.”

“Vigorous enforcement of the act allows us to protect not only taxpayer dollars but also the integrity of important government programs on which so many Americans rely,” West said.

The amount of money recovered in 2012 is up from $3.2 billion last year, and two-thirds of it was secured through the act’s whistleblower provisions.

“Many of these cases would not be possible without the whistleblowers . . . who have come forward to report fraud, often at great personal risk,” said Stuart Delery, the principal deputy assistant attorney general for the civil division.

The entire story is here.

Sunday, November 4, 2012

HHS IG pledges focus on Medicare billing abuse involving electronic records

Inclusion in IG work plan for 2013 follows Center's 'Cracking the Codes' series

By Fred Schulte
The Center for Public Integrity
Originally published October 24, 2012


Federal officials will focus on possible Medicare overbilling by doctors and hospitals that use electronic medical records, a top government fraud investigator said  Wednesday, in announcing investigative priorities for the coming year.

“Electronic medical records can improve quality of care and efficiency and help us uncover cases of fraud and abuse. At the same time, we must guard against the use of electronic records to cover up crime,” said Daniel Levinson, the Department of Health and Human Services inspector general, in a video presentation.

The video posted on the agency’s website on Wednesday summarized the inspector general’s “work plan,” for 2013, a listing of Medicare and Medicaid fraud fighting efforts the agency plans to emphasize.

The entire article is here.


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.




Saturday, October 13, 2012

91 Are Charged With Fraud, Billing Millions to Medicare


By REUTERS
Originally published October 4, 2012


Ninety-one people including doctors, nurses and other medical professionals were charged criminally after an investigation of Medicare fraud that involved $430 million in false billing in seven cities, officials said on Thursday.

It was the government’s second big raid in recent months after a similar investigation in May involving $452 million in possible fraud in Medicare, the health program for the elderly and disabled.

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The investigation is part of an effort by the Obama administration to find health care savings.

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.


Tuesday, June 12, 2012

Two South Florida doctors, 3 others convicted on Medicare fraud charges

A Miami federal jury convicted five people of Medicare-related fraud in a case involving the nation’s biggest mental-health racket.


By Jay Weaver
The Miami Herald
Originally published on June 1, 2012

Two South Florida doctors stared in disbelief — then teared up as they turned to relatives for comfort — after a federal jury found them guilty Friday of conspiring to defraud Medicare through the nation’s biggest mental-health racket.

The 12-person Miami jury convicted psychiatrists Mark Willner of Weston and Alberto Ayala of Coral Gables, the medical directors for American Therapeutic Corp., for their roles in a $205 million scheme to fleece the taxpayer-funded program for the elderly and disabled. The jurors found them not guilty on other healthcare fraud offenses.

In addition, the jury convicted Vanja Abreu, Ph.D, program director for American Therapeutic in Miami-Dade, of the same healthcare-fraud conspiracy offense, and two other defendants, Hilario Morris and Curtis Gates, of paying kickbacks to residential home operators in exchange for providing patients.

The entire story is here.

Thanks to Steve Ragusea for this story.

Monday, June 4, 2012

Missouri Psychologist Indicted for Health Care Fraud

by Staff Reporters
Kansas City InfoZine
Originally published May 27, 2012

Rhett E. McCarty, 67, of Lake Ozark, Mo., was charged in a two-count indictment returned under seal by a federal grand jury in Kansas City, Mo., on Wednesday, May 23, 2012. The indictment was unsealed and made public today upon McCarty’s arrest and initial court appearance in the U.S. District Court in Kansas City, Mo.

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 federal indictment alleges that since Aug. 22, 2008, McCarty has submitted Medicare and Medicaid claims for at least 19 beneficiaries for which he was paid $1,276,334.

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According to the indictment, McCarty forged (or caused another person to forge) the signatures of beneficiaries on patient sign-in sheets in order to obtain $418,507 in Medicare and Medicaid payments.

The whole story is here.

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

WellCare Health Plans whistle-blower to receive about $21 million

By Jeff Harrington
Tampa Bay Times
Originally published on April 4, 2012

Whistle-blower Sean Hellein will receive nearly $21 million for triggering a successful federal inquiry into Medicare and Medicaid fraud at his former Tampa employer, WellCare Health Plans.

Hellein in late February withdrew his objections to a pending $137.5 million civil settlement with WellCare. But the size of his payout was unclear until Tuesday, when U.S. Attorney Robert O'Neill announced the settlement of all four lawsuits initiated by whistle-blowers.

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.