Medicaid Fraud Cases
Press Release United States Attorney
Eastern District of Virginia
Paul J. McNulty, United States Attorney for the Eastern District of Virginia, announced that Darren Louis Stanford, age 32, of Richmond, Virginia, pled guilty today to one count of committing health care fraud and one count of possession with intent to distribute powder cocaine. Stanford faces a maximum sentence of ten years’ imprisonment, a $250,000 fine, and full restitution for the health care charge, and a maximum sentence of 20 years’ imprisonment and a $1 million fine for the drug charge when he is sentenced by United States District Court Judge Henry E. Hudson on October 28, 2005. The defendant was immediately remanded to the custody of the United States Marshals Service.
First of many? Vaccine probe may extend beyond Connecticut
Byline: Mark Taylor
This is an excerpt. Click the link to view the full document.
Last week’s settlement by a Connecticut hospital could be just the first as state Medicaid fraud-control units explore allegations that hospitals, physicians and other providers may be billing Medicaid and private insurers for children’s vaccines they received free, according to government sources and healthcare fraud experts.
Healthcare billing fraud consultant Robin Mathias, former director of data analysis and budget for Indiana’s Medicaid program, said the vaccine billing scheme has likely spread beyond Connecticut’s borders.
“Regardless of what the federal agencies are saying, I suspect that other Medicaid programs will be looking into whether they’ve been billed for the VFC free immunizations,” said Mathias, who advises health plans about fraud schemes. “Whether or not it was fraud or an honest error, those providers would have been essentially paid twice for the same service, and that’s illegal.”
She said hospitals, many of which operate outpatient, immunization and community clinics, could face liability.
The settlement resolves civil liabilities from alleged kickbacks paid to physicians, false statements made to obtain payment for unnecessary services, and payments made to Gambro Supply, a sham DME company.
Two owners of a South Florida treatment center for infectious diseases, a physician at the center and a nurse who served as its administrator, were arrested for their roles in a costly Medicaid fraud scheme, according to an October 1, 2004 press release from the Florida Attorney General. The scheme involved billing for prescriptions for medications that were never dispensed and the creation of false medical records to conceal the doctor’s absence from patient treatment and office supervision. Medicaid investigators seized over $1.6 million in illegally purchased assets, including a 40-foot boat, an ocean-view condominium, and a Cadillac SUV.
“It’s all about the money,” was the operating creed of Hatch Dental, as described in a 42-count felony complaint filed by California Attorney General Bill Lockyer on September 22, 2004. The complaint describes how 20 defendants affiliated with three Hatch Dental clinics let greed rule their practice at the expense of patient health and safety.
In spring of 2002, when Brian Kanarek, DDS asked defendant Kyon Maung Teo (the alleged ringleader) why he over-diagnosed treatment, Teo told him, “Something has to pay for this practice.” After Kanarek diagnosed only 2 fillings for a patient whom Teo diagnosed 26, Teo told him to leave Hatch Dental “and don’t come back.”
September 29, 2004 the Florida Attorney General announced that Dr. Suzanne Abergel-Nahon had used unlicenses staff to perform dental procedures for Florida Medicaid patients. The scam cost Florida Medicaid at least $260,000. From January 2000 to August 2004, Dr. Abergel-Nahon submitted claims for more than $3 million. Some of those claims were for services such as fillings, crowns, extractions, dentures, and root canals that were billed as if she provided them, when in fact, unlicensed staff performed the services.
Florida officials were probably able to find the fraud because of high billing by the provider. Data analysis algorithms can identify dentists who have such high billing it is unlikely that they could have performed all the work themselves. Once the dentist has been flagged, a simple investigation involving some phone calls and a site visit can identify who works for the dentist, what licensing they have and who actually performed the services.
On June 22, 2004 Dr. Romulo Valdez, a San Diego physician, pleaded guilty to conspiracy to defraud Medicare and Medi-Cal of more than $725,000. He admitted that he signed Certificates of Medical Necessity for motorized wheelchairs for patients who did not need them. In doing so, he helped Benison Medical Supply defraud Medicare and Medi-Cal. Dr. Valdez faces a maximum penalty of five years in prison and a $250,000 fine.
Motorized wheelchair fraud is a problem across the US. Expect to see more about this type of fraud. See also: 2 Brothers Plead Guilty
Operation Free Shot is tracking down doctors who charge Medicaid for immunizations that were paid for by the Vaccines for Children (VFC) program. VFC is an immunization program funded jointly by state and federal government. The Department of Public Health distributes vaccines to doctors and clinics for free. In May 2004, Jorge Elias, a Norwalk, CT doctor, pleaded guilty to healthcare fraud. He had charged Medicaid and other insurers for these free vaccines. In all he collected over $220,000 for vaccines that were already paid for by the government. Elias has agreed to pay $222,920 to the government, as well as $108,000 to private insurers. He could face jail time as well.