Medicaid Fraud Cases
Wheelchair fraud is in the news again, as two men in Texas pleaded guilty to submitting fraudulent claims to Medicare for power wheelchairs. In the past year, the Federal government has taken many steps to crack-down on power wheelchair fraud. In February 2004, the Deptartment of Justice announced 11 arrests in Texas as the result of Operation Roll Over. In September 2003, the Centers for Medicare and Medicaid Services (CMS) announced Operation Wheeler Dealer, a ten point plan to curb wheelchair fraud in the Medicare program. At the end of April 2004, CMS announced new payment guidelines to make sure that people who need wheelchairs get them and people who don’t, don’t.
Florida authorities have arrested participants in an alleged $10 million prescription drug fraud ring. Carlos Luis, Adalberto Hernandez, Edward Safille, Eddie Mor and Javier Rodriguez allegedly sold counterfeit Serostim to undercover authorities. The Florida Attorney General reports that Lupron and Serostim were diverted from Medicaid and other sources through multiple corportations owned by the defendents.
Serostim is a prescription growth hormone used to treat wasting disease associated with AIDS. Body builders use the drug illegally. A typical prescription is $7,000 to $8,000 for a one-month supply. After Medicaid or private insurance pays for the drugs, dealers often sell them on the street. There have been cases of this all across the country, including New Jersey and California.
The State of Florida accused Dr. Armando Angulo of inappropriately prescribing over $2 million of Oxycontin and other narcotics since 2000. According to this article, Dr. Angulo even let clinic staff hand out pre-signed prescriptions on days he was not in the office.
Read my article about Oxycontin abuse
The Michigan Attorney General’s Office alleges that pregnant women from Lebanon, Syria and Yemen came to the US to deliver their babies. They applied for Medicaid in Michigan claiming that they intended to remain Michigan citizens (a requirement for obtaining emergency Medicaid coverage). Michigan Medicaid paid for the deliveries, then the women returned to their home countries.
In June 2003 Hattie and Barry Bull, owners of “H and B Transportation,” pled guilty to overcharging Delaware’s medical assistance program and overstating mileage on patient trips. They were ordered to pay $100,000 in restitution and $12,930 in fees to the Attorney General. They were sentenced to a five year prison term which was suspended for probation.
The New Jersey Office of Insurance Fraud Prosecutor has announced guilty pleas in several pharmacy fraud cases in 2003. New Jersey has clearly made a great effort to crack down on pharmacy fraud in the New Jersey Medicaid program. Cases include fraudulent billing for Serostim, a podiatrist writing fraudulent prescriptions, and an undercover bust.
Michael Baer pled guilty to submitting over $20,000 in fraudulent insurance claims and for using “runners” to bring in patients. Between May and November 2000 Baer submitted claims to Parkway Insurance Company and Hanover Insurance Company for services that they did not provide. He also admitted to hiring runners who bring in patients so a medical provider can bill their insurance.
Kansas Medicaid paid Pamela Sayers almost $20,000 for services she did not provide to her grandmother. Sayers was a Home and Community Based Services attendant. She submitted false time sheets for home based services for her grandmother, but her grandmother was in a nursing home at the time.
Mark Sharp was convicted of more than $1.6 million in fraudulent Medicaid billing in Georgia. Sharp’s “Center for Families” mental health centers contracted with psychiatrists and psychologists to provide mental health services to Medicaid recipients, and Sharp’s company handled the billing.