This week three cases involving the fraudulent billing of Medicare for services or supplies that were never provided illustrate that Medicare Fraud is pervasive nationwide.

In Louisville, Kentucky authorities are tracking down Rodolfo Bouza owner of Newberg Services Inc., for fraudulently billing Medicare for $750,000 for bandages and durable medical equipment that were never produced.  In court documents Bouza’s scheme allegedly started in Miami, Florida and spread nation wide.

In Kittery, Maine Peter Ensinger was convicted for billing Medicare and other insurance companies for products that were never delivered to the patients, billing for more expensive products than the product that was actually delivered, and for continuing to bill for the product after the patient had returned the equipment.

In Humble, Texas Lula Thurman pleaded guilty to bilking Medicare and Medicaid of $483,833 by utilizing special modifier codes established for replacing medical equipment lost or damaged during a catastrophe or disaster such as Hurricane Katrina.  Thurman, owner of LT’s Faith-N-Action provided her customers new wheelchairs utilizing this code even though the customers did not qualify to receive the equipment under that code.

On Tuesday October 11, 2011, the Department of Justice sentenced Mr. Bassey Monday Idiong, of Humble, Texas, to thirty-three months in prison for his role in a Medicare Fraud scheme.

The fraud involved billing  Medicare for expensive orthotics referred to as “arthritis kits” that were medically unnecessary.  Each arthritis kit cost approximately $4,000.  According to the Department of Justice’s press release dated October 12, 2011, court documents showed that Mr. Idiong billed Medicare for two such kits for a beneficiary that only had one leg.

Additionally, Mr. Idiong paid patient recruiters kickbacks in exchange for Medicare beneficiary names for whom Mr. Idiong would submit billing to Medicare.

In total Mr. Idiong, through his company B.I. Medical Supply L.L.C. billed Medicare approximately $846,000 in fraudulent charges.

In addition to Mr. Idiong’s prison term, he was also ordered to pay $527,023 in restitution.

As discussed in previous blogs, the home health industry is blatantly ripping off Medicare to the tune of hundreds of millions of dollars.  The Medicare Fraud Strike Force is slowly making inroads into this area of fraud.  With continued funding, and successful prosecution, this Strike Force may actually decrease the incidence in fraud in this health field industry.

According to a USA Today article printed on September 2, 2011, government health care fraud prosecution, in the first eight months of 2011, was 85% higher than last year.  This rise is attributed to increased funding and improvements to investigative tools such as the creation of HEAT task force – discussed in previous blogs.

If the first two weeks of September 2011 are an indication, these numbers are going to continue to rise and quickly.  On September 2, there were two reports of Medicare fraud convictions.  The first one out of Miami Florida, where Jasmine Williams of Thirdage.com reported that a Miami area nurse pled guilty to Medicare fraud charges for home health services that were either medically unnecessary or never provided.  Between 2006 and 2009, this nurse, Farah Perez, recruited Medicare beneficiaries who allowed the Florida Home Health Care Providers, Inc. to bill for medicare services.  In exchange for these referrals, Nurse Perez received kickbacks from the home health company.

The second story reported September 2, 2011, comes from Detroit, where Robert Snell of detnews.com reported the prosecution of eighteen people in Detroit for Medicare fraud.  In what appears to be a disturbing trend in health care prosecution – fraudulent billing for home health services – these eighteen people were prosecuted for billing Medicare for home health services that were not medically necessary or even provided.  This particular scheme included billing for psychotherapy services for persons who were dead.

The Medicare Strike Task force, part of HEAT,  announced today, September 8, 2011,  its indictment of 91 people nationwide who fraudulently billed Medicare to the amount of 295 million.  The accused include doctors, nurses and other health care professionals who fraudulently billed for a wide spectrum of medical goods and services including home health care services.  In Houston, Texas two people are responsible for $62 million in false billing for home health care services and durable medical equipment.  In another trend in Medicare fraud, the durable medical equipment equates to wheelchairs.  As in the other two cases mentioned above, these Houstonians are accused of providing Medicare benificiaries’ information to home health service companies in exchange for kickbacks.  The home health service companies then billed Medicare for services that were medically unnecessary or never provided.

As is evident in these three reports of health care fraud, and in other posts from The Healthcare Fraud Blog, fraud is rampant in the home health service industry.  The most common fraudulent billing is for wheelchairs and services that are not medically necessary or were never provided.  Hopefully with continued success and funding the government’s task force will be able to identify fraudulent billing before it reaches the dizzy proportions such as the indictment reported today.