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Robin Mathias Quoted in Modern Healthcare

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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.

New Jersey Businessman Inflated More Than 4,000 Hours Of Therapy

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TRENTON - Division of Criminal Justice Director Vaughn L. McKoy announced that a former Bergen County certified public accountant has agreed to pay $325,000 in restitution after pleading guilty to Health Care Claims Fraud for inflating and submitting fraudulent insurance claims for medical services that were never provided to patients. At the March 7 guilty plea hearing, Cohen admitted that between Jan. 15, 1998 and April 30, 2001, he knowingly submitted dozens of health care claims to insurance companies and/or self-funded health benefit plans for patient therapy and related treatments by adding additional hours and/or dates of therapy which were never provided.

Florida Sues Unlicensed Physician for Medicaid Fraud

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TALLAHASSEE - Attorney General Charlie Crist today filed a civil complaint against a suspended Tampa physician alleging that the doctor billed Medicaid for more than $200,000 for services never provided. Dr. Lehel Kadosa was charged with violations of Florida’s False Claims Act following an investigation by the Attorney General’s Medicaid Fraud Control Unit. The suit alleges that Kadosa fraudulently billed Medicaid for injections designed to relieve lower back pain. The submitted bills included amounts charged for imaging that is supposed to verify that the needle is inserted in the correct position. However, investigators determined that Kadosa did not use imaging and instead blindly inserted a needle into the patient’s lower back, potentially placing his patients at risk. Medicaid was then improperly billed for the use of imaging that never took place.

Database giant gives access to fake firms (MSNBC)

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By Bob Sullivan Technology correspondent MSNBC Updated: 6:38 p.m. ET Feb. 14, 2005 Criminals posing as legitimate businesses have accessed critical personal data stored by ChoicePoint Inc., a firm that maintains databases of background information on virtually every U.S. citizen, has learned.

Modesto Chiropractor Fraud Widens

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According to the Modesto Bee, officials raided Med-1 Medical Center this morning at 7 AM. See Modesto Chiropractor (Department of Insurance) for details about the charges that owner Wilmer Dorado Origel defrauded insurers for $10 million over 9 years. Origel’s defense attorney is, of course, proclaiming his client’s innocence, “I’ve spent a lot of time talking to the doctor and going through how they structured their business. There’s nothing there. They can search anything they want.”


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TRENTON - Division of Criminal Justice Director Vaughn L. McKoy announced that a Hunterdon County woman has pleaded guilty to Health Care Claims Fraud and forgery for submitting more than 40 fraudulent health insurance claims worth more than $13,900. According to Director McKoy and Insurance Fraud Prosecutor Greta Gooden-Brown, Carol Severe, 65, Hamden Road, Annandale, Hunterdon County, pleaded guilty before Hunterdon County Superior Court Judge Robert Reed to a criminal Accusation filed by the Division of Criminal Justice - Office of Insurance Fraud Prosecutor. The Accusation charged Severe with Health Care Claims Fraud (3rd degree) and uttering a forged document (4th degree). When sentenced on May 6, Severe faces up to six and a half years in state prison and a fine of up to $25,000. Severe may also face civil insurance fraud fines pursuant to the civil Insurance Fraud Prevention Act.

West Virginia Prescription Drug Ring Broken Up (WBNSTV)

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Six people are charged with welfare fraud in connection with the case. Six people are under arrest in connection with a prescription drug and welfare fraud ring in Boone County. State Troopers said ringleader Tara Kirk impersonated her co-workers while working at Madison Healthcare so she could call in false prescriptions for the painkiller hydrocodone. Police said the arrests of Michelle Chafin and Pamela Ward for prescription and welfare fraud led them to Kirk.

Abuses Endangered Veterans in Cancer Drug Experiments

Breaking News | Fraud Cases
By DEBORAH SONTAG “Scores of patients at the V.A. hospital in Albany were put at risk, and employees say bigger concerns were dismissed by officials.” Mr. Kornak, who pleaded guilty to fraud wasn’t even a physician, though patients knew him as “Dr. Kornak.” This article reads like a vignette right out of “Catch Me If You Can,” the story of Frank Abagnale, a notorious scam artist.

5 Cases Settled in West Virginia

News and Commentary | Fraud Cases
U.S. attorney says he’s serious about health care fraud,

U.S. Attorney E. Thomas Johnston announced plea agreements of five healthcare fraud cases.

The article describes the settlements with five providers:

  • Dr. William C. Dressler of Martinsburg, WV was charged with upcoding.
  • Dr. Sadtha Surattanont of Romney, WV agreed to settle charges of upcoding by paying $195,000 and agreeing to five years of monitoring of his participation in Medicaid and Medicare.
  • Dr. Harry D. Price of Martinsburg, WV allegedly filed false claims from 1997 to 2002.

NJ Pharmaceutical Company Employees Sentenced to Prison for Selling Drug Samples, Defrauding Schering-Plough

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NEWARK - Two former employees of major New Jersey pharmaceutical companies were sentenced today for the illegal sale of nearly $300,000 in prescription drug samples to pharmacies in New Jersey and Florida, as well as a separate scheme to defraud Schering-Plough Corp. of more than $500,000, U.S. Attorney Christopher J. Christie announced. U.S. District Judge Faith S. Hochberg sentenced former Schering-Plough employee Alexander Best, 35, of Lincoln Park, to 16 months in prison and ordered him to pay $547,331 in restitution to Schering-Plough. Former Novartis sales representative Philip Zamloot, 35, also of Lincoln Park, was sentenced to 12 months in prison and ordered to pay $156,997 in restitution to Schering-Plough.
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