September – A Banner Month for Health Care Fraud Prosecution
September 8th, 2011
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.