Unlicensed Therapist Convicted For Stealing $450,000 From Medicaid

UNLICENSED THERAPIST CONVICTED
FOR STEALING $450,000 FROM MEDICAID
Faces up to 3 years in State prison

Attorney General Eliot Spitzer today announced that a Brooklyn man has pleaded guilty in Albany County Court to stealing more than more than $450,000 from the Medicaid program.

United States Attorney
Southern District of New York
FOR IMMEDIATE RELEASE
DECEMBER 6, 2005

UNITED STATES INTERVENES IN FALSE CLAIMS ACT LAWSUIT
AGAINST CABRINI MEDICAL CENTER ALLEGING ILLEGAL
MEDICAID PATIENT REFERRAL SCHEME

MICHAEL J. GARCIA, the United States Attorney for the Southern District of New York, announced today that on December 2, 2005, the Government filed a civil complaint against CABRINI MEDICAL CENTER (“CABRINI”). The complaint alleges that CABRINI entered into an illegal patient referral scheme with APPLIED CONSULTING, INC. (“CONSULTING”), and then falsely billed Medicaid for the care of these illegally-referred patients. CABRINI also allegedly billed Medicaid for alcohol and substance abuse detoxification treatment that it was not certified to provide.

HHS-OIG - Press Release

OIG Proposes To Exclude Miami Hospital from Participation in Federal Health Care Programs

December 7, 2005 Washington, DC 20201

OIG Proposes To Exclude Miami Hospital from
Participation in Federal Health Care Programs

Inspector General Daniel R. Levinson announced today that the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) notified Miami’s South Shore Hospital and Medical Center (South Shore) of an impending exclusion from Medicare, Medicaid, and all other Federal health care programs. Today’s action resulted from South Shore’s material breach of the terms of a corporate integrity agreement (CIA) it negotiated with OIG in 2002, as part of the resolution of a False Claims Act case against the hospital.

Herald.com | 12/02/2005 | Four arrested in AIDS drug scam

BY JOHN DORSCHNER

jdorschner@herald.com

In what could be the start of a massive crackdown on scams involving HIV/AIDS patients, law enforcement officials announced the arrest of four persons, including two doctors, charged with illegally diverting millions of dollars in drugs.

I don’t usually focus on beneficiary fraud, but sometimes there are some extreme cases that I think are worth mentioning for the sheer gall of their actions. TennCare cracked down on beneficiary fraud in 2005 and has been prosecuting many interesting cases.

State Medicaid Probe Obtains $7 Million Repayment

STATE MEDICAID PROBE OBTAINS $7 MILLION REPAYMENT

Attorney General Eliot Spitzer today announced that Americare Certified Special Services, Inc. (Americare), a Brooklyn based certified home health agency, has agreed to pay $7 million as part of a resolution of an investigation whether it had improperly billed Medicaid for services rendered to residents in adult homes. Home Health Agencies such as Americare provide health care to persons living in their own homes, and also in “adult homes” which are residential facilities that do not provide skilled nursing care.

Nursing home fraud alleged in indictments (Jefferson City News Tribune) - ST. LOUIS (AP) - A federal grand jury returned indictments Thursday on charges that several nursing home operators conspired to defraud Medicare and Medicaid by collecting payments for services they did not provide to their residents.

Press Release from: McGregor W. Scott, United States Attorney, Eastern District of California

FOR IMMEDIATE RELEASE Contact: Patty Pontello, 916-554-2706
November 15, 2005

DOCTORS ACCUSED OF PERFORMING UNNECESSARY HEART SURGERIES AT REDDING MEDICAL CENTER AGREE TO PAY MILLIONS TO SETTLE FRAUD ALLEGATIONS AND ACCEPT RESTRICTIONS ON THEIR MEDICAL PRACTICE

• The Agreement Preserves the Right to Revoke the Doctors’ Licenses and Exclude Them From the Medicare Program.

According to the article by Judith R. Tackett, TennCare is increasing their focus on beneficiary fraud through their new Office of Inspector General:

“Faulkner, who was appointed by Gov. Phil Bredesen in July 2004 to establish the state’s Office of Inspector General, said Tennessee is ahead of the game when it comes to fighting TennCare fraud. Her office targets TennCare recipients committing fraud while the TBI concentrates on provider fraud.

From the North Country Gazette:

“The owner of a Westchester County transportation company has admitted to stealing more than $400,000 from the state Medicaid program by fraudulently billing for hundreds of rides that never took place and for rides that were not authorized by medical practitioners.

Meir Sassoon, president of Saswitz Corporation, appeared before Westchester County Court Judge Rory J. Bellantoni, on Sept.1 and pleaded guilty to every count of an indictment which charged him with one count of grand larceny in the second degree and 25 counts of offering a false instrument for filing in the first degree. The defendant agreed to make full restitution to the New York State Medicaid program, in the sum of $437,845.51, before sentencing on Sept. 28.. Saswitz Corporation previously pled guilty to grand larceny in the second degree.