Fraud Cases

Wisconsin Chiropractor Sentenced

Chiropractor Fraud Cases | Fraud Cases

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.

Miami Dentist Uses Unlicensed Staff

Dental Fraud Cases | Fraud Cases | Medicaid Fraud Cases

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.

eBay Used for Medical Supply Fraud

News and Commentary | Fraud Cases | Medical Equipment Fraud Cases

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

Fraudulent Certificates of Medical Necessity

Fraud Cases | Medicaid Fraud Cases | Medical Equipment Fraud Cases

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

Fraud Cases | Medicaid Fraud Cases | Prescription Drug Fraud

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.

$8 Million Medicare Kickback Scheme

Fraud Cases | Kickbacks
Fourteen defendants have been charged with participating in an $8 million Medicare fraud scheme. Three therapy companies allegedly paid kickbacks to assisted living facilities and physicians to get patient referrals. According to the August 4, 2004 press release by United States Attorney for the Southern District of Florida, the therapy companies billed for unnecessary services for these patients and doctored documentation to support their billing. To hide the money obtained through this fraud ring, Ricardo Choi, Mark Anthony Mignott and Elliott Housley, owners of the therapy companies, allegedly transferred the money to off-shore accounts and to shell companies.

7 Charged in Florida DME Fraud

Fraud Cases | Medicaid Fraud Cases | Medical Equipment Fraud Cases
A 79-count Indictment charged Lazaro Betancourt, Carlos Marx Mesa, Kenia Mesa, Osvaldo Piedra, Viridiana Negrin, Gilberto Herrera, and Guillermo Carnet with healthcare fraud against Medicare, as well as money laundering and check cashing schemes. According to an August 5, 2004 press release by the United States Attorney for the Southern District of Florida, the people indicted created durable medical equipment (DME) companies that billed Medicare for services which were not delivered to Medicare beneficiaries. The defendents allegedly laundered the money they received from Medicare. A money laudering conviction could result in a maximum sentence of 20 years in prison. Financial penalties could amount to $21 million (treble the $7 million identified as Medicare fraud.).

Hospital accused of Medicare fraud

News and Commentary | Fraud Cases | Kickbacks
Hospital accused of Medicare fraud (Miami Herald) - Larkin Community Hospital, in South Miami, and many connected with it are alleged to have bilked Medicare of millions of dollars. [Healthcare Fraud News] According to this article, “At one point, the civil suit states state regulators found that half of all care being given in the small South Miami hospital was medically unnecessary.” The article describes two scams. The first scam involves alleged kickback payments to Jack Jacobo Michel, a physician who later bought the hospital. The second scam involves kickbacks to long-term care facilities, some of which were owned by Jack Jacobo Michel, who at that time, also owned the hospital.

Doctor Indicted: Chemotherapy Drug Scam

News and Commentary | Fraud Cases | Prescription Drug Fraud
Doctor Indicted - A Middle Tennessee doctor has been indicted on healthcare fraud charges. Dr. Young Moon practices in Crossville. [Healthcare Fraud News] This is part of a trend that first gained national attention in 2001, when Robert Courtney, a pharmacist, was indicted for diluting chemotherapy drugs. He pleaded guilty in 2002. Since the effectiveness of chemotherapy varies greatly, patients don’t know for sure whether they are getting full doses.

AG Announces Indictment of Clinical Social Worker for Health Care Fraud

News and Commentary | Fraud Cases
AG Announces Indictment of Clinical Social Worker for Health Care Fraud - Oregon Attorney General Hardy Myers today announced that Robert F. White, a licensed clinical social worker in Manzanita, was indicted by the Tillamook County Grand Jury. [Healthcare Fraud News] The Attorney General’s Office accused Mr. White of billing for services that were not rendered.
XML feed