A Focus on Healthcare Fraud

In Fraud, White Collar by Jason Freeman2 Comments

Federal prosecutors recently announced the conviction of the former office manager of a home health care company for conspiring to commit Medicare fraud.  The case, which was brought as part of the Medicare Fraud Strike Force, demonstrates the way that federal government agencies coordinate through investigative partnerships to prosecute health care fraud.  The defendant in the case, the manager of Mercy Home Care Inc. (Mercy) and a billing employee for D&D&D Home Health Care Inc. (DDD), was convicted following a two-week jury trial on charges that he conspired to commit health care fraud and wire fraud, as well as one count of conspiring to defraud the United States and pay and receive health care bribes and kickbacks.

According to prosecutors, evidence at trial showed that he and his co-conspirators used the companies to submit false claims to Medicare that were based on services that were not medically necessary, not actually provided and for patients that were procured through the payment of illegal kickbacks to doctors and patient recruiters.  In an attempt to support the false claims, prosecutors claimed that the defendant’s co-conspirators forged prescriptions and other medical records, and that he submitted claims to Medicare based on the falsified documentation.  All told, according to DOJ in its recent release, evidence produced at trial showed that Medicare paid nearly $2.5 million for false and fraudulent claims that were submitted by Mercy and DDD between October of 2014 and June of 2015.

Here’s a copy of the original indictment.  It charged Leon and several co-conspirators with several specific criminal counts, including:

  • conspiracy to commit health care fraud and wire fraud in violation of 18 U.S.C. 1349;
  • health care fraud in violation of 18 U.S.C. 1347; payment of kickbacks in connection with a Federal Health Care Program in violation of 42 U.S.C. 1320a-7b(b)(2)(A); and
  • conspiracy to defraud the United States and Pay and Receive Health Care Kickbacks in violation of 18 U.S.C. 371.

The last count—the general federal conspiracy charge—raised the following more specific allegations as part of the alleged general conspiracy:

[a violation of] Title 42, United States Code, Section 1320a-7b(b)(2)(A), by knowingly and willfully offering and paying remuneration, including kickbacks and bribes, directly and indirectly, overtly and covertly, in cash and in kind, to a person to induce such person to refer an individual to a person for the furnishing and arranging for the furnishing of any item and service for which payment may be made in whole and in part by a Federal health care program, that is, Medicare.

[a violation of] Title 42, United States Code, Section l320a-7b(b)(1)(A), by knowingly and willfully soliciting and receiving remuneration, including kickbacks and bribes, directly and indirectly, overtly and covertly, in cash and in kind, in return for referring an individual to a person for the furnishing and arranging for the furnishing of any item and service for which payment may be made in whole and in part by a Federal health care program, that is, Medicare.

Again, the case was brought as part of the Medicare Fraud Strike Force.  The Medicare Fraud Strike Force has charged nearly 3,000 defendants with collectively billing the Medicare program for more than $11 billion since its inception.  Medicare fraud continues to be a priority with the Department of Justice.

Comments

  1. We have always been skeptical of the doctors who order unnecessary tests to line their pockets. Now we learn of them billing Medicaid for tests that aren’t even being performed? And we wonder why healthcare costs are on the rise.

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