As part of a no contest plea to one count of fraud, Wisconsin chirpractor Barbera Bergman will give up her license number and Medicaid number. She was sentenced to 18 months probation on August 20, 2004. She’ll also be required to pay a $1,000 fine and complete 100 hours of community service.
Dr. Tony D. Hjelle, Bergman’s employer, fired Bergman after he noticed that she had altered patient records. He believes she upcoded hundreds of claims before and after he purchased her business.
According the complaint filed by the Wisconsin Medicaid Fraud Control Unit (MFCU), Bergman billed Medicaid for services she did not provide.
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.
In Washington last week, deputies arrested Sally Hansen after they caught her selling medical supplies on eBay. The supplies were allegedly paid for by Washington state for Hansen’s disabled child. The Seattle Post-Intelligencer reported thta the state Department of Social and Health Services paid $15,100 for diapers, fruit drinks, PediaSure and a state employee health insurance program paid about $23,000 for medical supplies for Hansen’s daughter.
The investigation reportedly started after Wanda DeGolier bought PediaSure from Hansen on eBay. Ms. DeGolier contacted the medical supply company after she noticed that a label on the box that said the supplies were intended for Hansen’s daughter. Read the Seattle Post-Intelligencer article
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.