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Fraud and Compliance Update
10/4/2019 (AHLA)
Nearly three dozen individuals across five federal districts are facing charges for their alleged roles in defrauding Medicare of more than $2.1 billion for expensive cancer genetic testing that was medically unnecessary, the Department of Justice (DOJ) announced September 27.
The 35 individuals are associated with dozens of telemedicine companies and genetic testing laboratories and include ten medical professionals, DOJ said in a press release.
A coordinated federal investigation of DOJ’s Criminal Division, the Department of Health and Human Services Office of Inspector General, and the Federal Bureau of Investigation targeted the alleged scheme, which involved laboratories paying illegal kickbacks and bribes to medical professionals working with fraudulent telemedicine companies in exchange for referrals of Medicare beneficiaries for the costly cancer genetic tests, prosecutors said.
Defendants allegedly paid doctors to prescribe the testing without any patient interaction or only a brief conversation over the phone. The test results often were not provided or were worthless, DOJ alleged.
Certain defendants, including CEOs and CFOs, allegedly controlled a telemarketing network that targeted elderly or disabled patients, convincing them to sign up for the unnecessary genetic tests.
“The scope and sophistication of the health care fraud detected in Operation Double Helix and the related Operation Brace Yourself is nearly unprecedented,” said U.S. Attorney for the Southern District of Georgia Bobby L. Christine.
Meanwhile, the Centers for Medicare & Medicaid Services (CMS) Center for Program Integrity announced administrative action against cancer genetic testing companies and medical professionals who submitted more than $1.7 billion in Medicare claims.
“CMS continues to use a comprehensive and aggressive program integrity approach that includes fraud prevention, claims review, beneficiary education, and targeting high-risk areas of the federal healthcare programs with new tools and innovative demonstrations,” said CMS Administrator Seema Verma.
The charges were brought in federal districts in Florida, Louisiana, Georgia, and Texas.
For example, in the Southern District of Florida, Richard Garipoli, who owned Lotus Health LLC, a telemedicine company, was charged with billing Medicare more than $326 million for medically unnecessary cancer genomic tests. Medicare paid more than $84 million of those claims.
Nineteen individuals were charged in the Southern District of Georgia, including two “telemedicine” physician recruiters, seven physicians, two nurse practitioners, two individuals who brokered the sale of physician orders, one company that brokered the sale of physician orders, and four durable medical equipment companies. Defendants allegedly were responsible for more than $400 million in genetic testing, durable medical equipment, and pain cream billing to Medicare, prosecutors said.
According to a press release, Marcus Anderson was charged in a 13-count indictment with health care fraud and aggravated identity theft for stealing providers’ identities to submit more than $1.2 million in false and fraudulent claims to Medicaid.
Teresa Johnson, who owned and operated Tri-County Medical Billing, was charged with conspiracy to commit health care fraud for allegedly submitting fraudulent claims to Medicare, Medicaid, Tricare, and ChampVA, on behalf of a medical doctor who owned several clinics in Florida.
In addition, Hong Truong, Jessica Evans, Lucretia Mullan, Robin Lloyd, and Patrice Jackson were charged in separate indictments with conspiracy to unlawfully distribute and dispense Schedule II controlled substances, among other charges.
Charges contained in the indictments are allegations only; all defendants are presumed innocent until proven guilty in court.
Fraud and Compliance Update
10/4/2019 (AHLA)
Fraud and Compliance Update
10/4/2019 (AHLA)
Health care fraud and enforcement efforts in Detroit, Chicago, and Minnesota resulted in charges against 53 individuals for their alleged roles in schemes to defraud Medicare and Medicaid by billing for procedures that were medically unnecessary or not provided and for prescription medications that were never purchased or distributed, the Department of Justice (DOJ) announced September 27.
In the Eastern District of Michigan, 20 individuals are facing charges for their alleged involvement in schemes that resulted in $144.8 million in fraudulent Medicare billings, prosecutors said in a press release. In the Northern District of Illinois, 12 individuals were charged in alleged bids to defraud Medicare of more than $103 billion. Seven of the those charged in the two federal districts were doctors or medical professionals.
Also, in Minnesota, 21 defendants, including two medical professionals, were charged with defrauding Medicaid of nearly $3 million.
“Today’s action in the Midwest are further proof of the Department’s steadfast commitment to investigating and prosecuting those who put their personal greed above the public good,” said Assistant Attorney General Brian A. Benczkowski of DOJ’s Criminal Division.
The indictments include allegations only. Defendants are presumed innocent until proven guilty in court.
Fraud and Compliance Update
10/4/2019 (AHLA)
U.S. Attorney for the District of Maine Halsey B. Frank announced that Meridian Mobile Health, LLC, doing business as Capital Ambulance, agreed to pay $138,285 to resolve allegation it violated the False Claims Act by billing for medically unnecessary nonemergency ambulance transportation.
According to a press release, the government alleged that from October 2016 through February 2018, Capital improperly billed Medicare for transporting patients discharged from Eastern Maine Medical Center (EMMC) who were not “bed-confined” and did not otherwise medically require ambulance transport.
The government also alleged the medical center provided Capital with certification statements containing incomplete or incorrect information about medical necessity, which the company used to bill Medicare.
Capital identified instances of billing and receiving Medicare payment for medically unnecessary nonemergency ambulance transports originating at EMMC and voluntarily disclosed this information to the government, the release said. The company also cooperated with the government’s investigation and implemented enhanced compliance and remedial measures, the release said.
A settlement is not an admission of liability.
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| After receiving correspondence from the Department of Labor notifying the practice owner of an audit, practice owners often ask, “Why am I being investigated?” The following list includes reasons and complaints that may instigate a Department of Labor audit investigation: |