Tag Archives: unnecessary services

South Florida Man Admits to a $42 Million Medicare Fraud Scheme

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The owner and operator of a Miami home health care agency pleaded guilty for his part in a $42 million home health Medicare fraud scheme, according to the Department of Justice (DOJ), the FBI and the Department of Health and Human Services (DHHS). The 43 year-old man pleaded guilty before a U.S. district court judge to one count of conspiracy to commit health care fraud on August 2, 2012.

To see the entire press release from the Department of Justice (DOJ), click here.

First Part of the Fraud Operation Involved Kickbacks and Bribes.

The Miami man was the owner of a Florida home health agency that claimed to provide home health care and physical therapy services to eligible Medicare recipients.

In the first part of the scheme, he allegedly would pay kickbacks and bribes to recruiters. In return, the recruiters would provide patients to the home health care agency. His patients, who received Medicare, were used to bill Medicare for $42 million in unnecessary home health care and therapy services, the government alleged.

The plea documents show that patients’ files were falsified to make it appear that these Medicare recipients qualified for the services when many actually did not.

Second Part of the Fraud Operation Included Paying off Doctors.

The second part of this operation involved the owner of the home health agency and his accomplices allegedly paying off doctors. In this exchange, the doctors would allegedly provide the schemers home health and therapy prescriptions, and medical certifications.

The Opertation Busted by the Medicare Fraud Strike Force.

In the end, the crimes resulted in $42 million in false and fraudulent Medicare claims that were filed between January 2006 and November 2009, according to the government. Medicare paid approximately $27 million on those false claims, according to plea documents.

As part of his plea agreement, the home health agency owner has agreed to forfeit two residential properties and cash proceeds of the fraud over to the government.

This case was investigated as part of the Medicare Fraud Strike Force. The Strike Force is a joint effort of the Department of Justice (DOJ) and the Department of Health and Human Services (DHHS) designed to combat fraud through the use of Medicare data analysis techniques.

To learn more on the Medicare Fraud Strike Force, click here.

Contact Health Law Attorneys Experienced in Handling Medicare Audits.

Medicare fraud is a serious crime and is vigorously investigated by the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), state Medicaid Fraud Control Units (MFCUs) and other law enforcement agencies participate. Don’t wait until it’s too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today.

The Health Law Firm’s attorneys routinely represent physicians, medical groups, clinics, pharmacies, home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Department of Justice, Office of Public Affairs. “Miami Home Health Care Agency Owner Pleads Guilty in $42 Million Medicare Fraud Scheme.” Department of Justice. Press Release. (August 2, 2012). From: http://www.justice.gov/opa/pr/2012/August/12-crm-965.html

CBS Miami “Health Care Agency Owner Pleads Guilty In $42M Medicare Scheme.” Miami CBS 4 Local. (August 2, 2012). From: http://miami.cbslocal.com/2012/08/02/health-care-agency-owner-pleads-guilty-in-42m-medicare-scheme/

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

New Hampshire City Auditing Ambulance Service for Allegedly Overbilling

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On July 16, 2012, a New Hampshire city allegedly launched an audit into its primary ambulance service, American Medical Response (AMR), after the company acknowledged overbilling hundreds of patients since 2011, according to a Union Leader article.

AMR Allegedly Incorrectly Billed More Than 300 Ambulance Trips.

According to the report, an in-house audit by the city showed that 323 ambulance trips out of nearly 5,000 in 2011 and 2012 had been incorrectly billed. This amounts to slightly more than six percent (6%). AMR attributes the overbilling to human error.

After concerns that the billing problems could be more widespread, it was decided the ambulance service should be audited by an independent auditor.

AMR is reported to have forgiven any outstanding incorrect balances and issued $16,000 in refunds to patients who had already paid the incorrect bills.

Patients’ Bills Allegedly Exceeded the Amount AMR was Authorized to Charge.

Residents describe a common bill for ambulance transportation to be more than $1,000 for a single ambulance trip, which is approximately sixty-six percent (66%) more than AMR is authorized to charge under its contract with the city.

The city began its contract with AMR in January 2011, after the city’s previous ambulance service went out of business. The city’s fire chief said that under AMR’s contract, the company cannot charge more than thirty-five (35%) above the Medicare rate.

AMR is allegedly cooperating in the review, but the audit will take about a month to complete.

Ambulance Services Companies Are Easy Targets for Medicare Audits.

Recently, ambulance service companies have become the target of Medicare audits and are frequently accused of billing Medicare for unnecessary services. Medicare and Medicaid audits can result in overpayment demands reaching into hundreds of thousands of dollars and assessment of fines. Ambulance services were included in the Department of Health and Human Services (DHHS) Office of the Inspector General (OIG) work plan for fiscal year 2012 as an area that would be subject to scrutiny. Zone Program Integrity Contractors (ZPICs) and Recovery Audit Contractors (RACs) are launching audits of ambulance service providers and emergency medical transportation companies.

Contact Health Law Attorneys Experienced in Handling Medicare Audits.

Medicare fraud is a serious crime and is vigorously investigated by the FBI and the U.S. Department of Health and Human Services (DHHS) Office of Inspector General (OIG). Don’t wait until its too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today.

The Health Law Firm’s attorneys routinely represent physicians, medical groups, clinics, pharmacies, ambulance services companies, durable medical equipment (DME) suppliers, home health agencies, nursing homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Siefer, Ted. “Independent audit begins on Manchester ambulance service billing.” Union Leader. (July 23, 2012). From: http://www.unionleader.com/article/20120724/NEWS06/707249979

Siefer, Ted. “City will conduct audit ambulance service over overbilling.” New Hampshire.com. (July 28, 2012). From: http://www.newhampshire.com/article/20120729/NEWS0603/707299953/1007

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

Hospital to Pay $3.59 Million to Settle False Claims Act Allegations Involving Ambulance Services

By Miles Indest

A hospital located in Columbia, Tennesse, has agreed to pay the federal government over $3.5 million to settle False Claims Act allegations that occurred between 2004 and 2009. The hospital submitted a voluntary self-disclosure to the U.S. Attorney’s Office and the Department of Health and Human Services (DHHS) Office of Inspector General (OIG).

Hospital Voluntarily Self-Reported After Compliance Program Revealed Billing Errors.

The hospital self-reported after its own compliance program revealed billing problems for ambulance services. The hopsital’s audit of billings reported faulty claims and payment for:

  • Ambulance services that were billed with incorrect mileage units;
  • Ambulance services that were not medically necessary or for which medical necessity was not documented;
  • Ambulance services for which a physician certification statement (PCS) was not obtained;
  • Ambulance services for which the requisite signatures were not obtained; and
  • Ambulance services that were assigned an incorrect transport level.

Hospital Works With U.S. Attorney’s Office to Resolve Billing Errors.

After notifying the U.S. Attorney’s Office that billing issues had been discovered, Maury Regional outlined a plan to determine the scope of these issues. The hospital then worked with the U.S. Attorney’s Office to bring the matter to resolution.

Ambulance Services Flagged for Medicare Audits.

In a Medicare audit of a hospital or ambulance company, ambulance services are frequently chosen for review. Ambulance services companies have increasingly become a target for Medicare audits and are often accused of billing Medicare for unnecessary services. Ambulance companies should have a compliance plan in place to assist in detecting any errors. Ambulance companies should also take all measures to prepare for a Medicare audit, before notice of an audit is received. To learn more about preparing for Medicare audits, click here.

Contact Health Law Attorneys Experienced with Medicare Audits and False Act Claims Cases.

The Health Law Firm represents ambulance companies, emergency transport services, physicians, medical practices, pharmacists, pharmacies, home health agencies, nursing facilities, hospitals, and other health provider in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving government health programs (Medicare, Medicaid, TRICARE). The Health Law Firm also represents health providers in False Claims Act cases.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources Include:

Humbles, Andy. “Maury Regional to Pay $3.5 Million to Settle False Claims Act Allegations.” Tennessean. (June 29, 2012). From: http://www.tennessean.com/article/20120629/NEWS21/306290078/Maury-Regional-pay-3-5-million-settle-False-Claims-Act-allegations

Staff. “Maury Regional Hospital to Pay $3.59 Million to Settle False Claims Act Allegations.” The Daily Herald. (June 29, 2012). From: http://www.columbiadailyherald.com/sections/news/local/maury-regional-hospital-pay-359-million-settle-false-claims-act-allegations.html

Man Charged with Medicare Fraud in Ambulance Scheme

By Miles Indest

A Pennsylvania man has been charged in a 23-count indictment in relation to an alleged scheme to defraud Medicare by billing for fraudulent ambulance services. The charges were announced by the Department of Justice (DOJ) on June 29, 2012.

Man Allegedly “Straw” Owner Used to Start Ambulance Company.

According to the indictment the man allegedly used a “straw” owner (someone who was not actually the owner) to fraudulently open Starcare Ambulance because he was otherwise ineligible to own the company. Between 2006 and 2011, the man allegedly billed Medicare for transporting kidney dialysis patients who did not medically need ambulance service. This indictment seeks forfeiture of over $5 million in cash as well as a GMC Hum-V (“Hummer”) vehicle.

Man Could Face Up To 10 Years in Prison for Each Count of Health Care Fraud.

If convicted of all charges, the defendant faces a statutory maximum sentence of ten years in prison on each of the health care fraud and conspiracy counts. He also faces five years in prison for aiding and abetting in false statements relating to health care fraud, a three year term of supervised release, and a fine of up to $250,000.

Ambulance Services Companies Are Target for Medicare Audits.

In recent years, and especially in 2012, ambulance services companies have become the target of Medicare audits and are frequently accused of billing Medicare for unnecessary services. Medicare and Medicaid audits can result in overpayment demands reaching into hundreds of thousands of dollars and assessment of fines. Ambulance services were included in the Department of Health and Human Services (DHHS) Office of the Inspector General (OIG) work plan for fiscal year 2012 as an area that would be subject to scrutiny. Zone Program Integrity Contractors (ZPICs) and Recovery Audit Contractors (RACs) are launching audits of ambulance service providers and emergency medical transportation companies.

Contact Health Law Attorneys Experienced in Handling Medicare Audits.

Medicare fraud is a serious crime and is vigorously investigated by the FBI and the U.S. Department of Health and Human Services (DHHS) Office of Inspector General (OIG). Don’t wait until its too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today.

The Health Law Firm’s attorneys routinely represent physicians, medical groups, clinics, pharmacies, ambulance services companies, durable medical equipment (DME) suppliers, home health agencies, nursing homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources Include:

“Pennsylvania Man Charged With $5.4 Million Medicare Fraud.” San Francisco Chronicle. (June 29, 2012). From: http://www.sfgate.com/news/article/Pa-man-charged-with-5-4-million-Medicare-fraud-3674333.php

Department of Justice, Office of Public Affairs. “Pennsylvania Man Charged with Fraud in Ambulance Scheme.” Department of Justice. Press Release. (June 29, 2012). From: http://www.justice.gov/opa/pr/2012/June/12-crm-840.html