Wisconsin Senior Medicare Patrol » Medicare

Two Cases Uncover $49 Million Fraud

awinder — Tue, 31 Jan 2012 04:50:34 +0000

Two individuals have pleaded guilty in the case of a Miami health care agency’s acts of health care fraud. Marietha Morales, 38, and Eduardo Saborit-Dominguez, 48, each face up to 10 years in prison. Under a federal endictment, Morales and Saborit-Dominguez were charged with conspiring to bill Medicare for unnecessary home health care and therapy services on behalf of Prime Home Health Services Inc. to the tune of $22 million. The pair admitted to paying kickbacks and bribes to patient recruiters in return for the recruiters providing patients to Prime Home Health. The case was investigated by the FBI and HHS-OIG, and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Miami.

In a second case from Miami, an area nurse has pleaded guilty to participating in a $25 million home health Medicare fraud scheme. Jorge Pineiro, 42, was charged in February 2011 with conspiracy to commit fraud. Pineiro worked for two Miami area home health care agencies, ABC Home Health Care Inc. and Florida Home Health Care Providers Inc. Pineiro and others billed Medicare for unnecessary services or services that were never provided. Dr. Jose Nunez is a co-defendant in the case. He’s charged with prescribing medically unnecessary services. Both were charged after it was discovered they had falsified patient files for Medicare beneficiaries to make it appear that they qualified for home health care and therapy services. Pineiro also solicited and received kickbacks and bribes from the owners and operators of Florida Home Health in return for allowing the agency to bill Medicare on behalf of the patients he recruited even though they didn’t qualify.There are 18 total co-defendants in this case. In addition to potentially spending 10 years in prison, defendants also face fines and supervised release, as well as forfeiture of any property or proceeds derived from criminal activities.

To read more about either of these cases, click here.

More than $4 Million in Fraudulent Charges Uncovered

awinder — Mon, 23 Jan 2012 22:14:12 +0000

The Department of Health and Human Services, Office of the Inspector General (HHS-OIG), with the collaboration of the United States Secret Service (USSS) and the Federal Bureau of Investigation (FBI) has uncovered a massive health care fraud operation that led to the arrests of 10 people. They include the presidents and employees of four medical organizations, Monte Mar Health Corporation (Monte Mar), PROMEDS Medical Inc. (PROMEDS) Quality Care Medical Supply (Quality), and Preferred Medical Equipment (PME). In multiple indictments the businesses were charged with filing fraudulent claims to Medicare for Durable Medical Equipment and other unnecessary costs. Physician Francisco Garrastegui was allegedly in on the scams by accepting kick-backs for signing and completing false progress notes, prescriptions, Certificates of Medical Necessity (CMNs) and Statements of Ordering Physician for Medicare beneficiaries that were billed by Monte Mar, PROMEDS, Quality, and PME. Others involved are charged with creating and submitting fraudulent claims to Medicare. If found guilty the defendants could spend 10 years in prison.

Woman Pleads Guilty in $200 Million Medicare Fraud Case

awinder — Fri, 20 Jan 2012 22:01:05 +0000

The Department of Justice, the FBI and the Department of Health and Human Services (HHS) together have been investigating the case of $200 Million in fraudulent claims to Medicare under the guidance of American Therapeutic Corporation (ATC); its management company, Medlink Professional Management Group Inc.; and the American Sleep Institute (ASI). Involved in the scheme was Sandra Jimenez, 38. She admitted in a district court in Miami that she conspired to commit health care fraud and that she was involved in paying and receiving illegal health care kickbacks. She admitted to billing for unnecessary Medicare services and recruited beneficiaries to home health who were not actually eligible for the services. Jiminez’s involvement in multiple schemes accounted for $46 million in fraudulent billings to the Medicare program. Jimenez faces a maximum penalty of 15 years in prison and a $250,000 fine when she is sentenced in June. The case was investigated by the FBI and HHS-OIG, and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida. The Medicare Fraud Strike Force is charged with looking for other fraudulent providers like Jimenez, who all together, have charged billed more than $2.9 billion to Medicare.

Find more details about this case here.

Reading Your Medicare Statement is a Necessary Practice

awinder — Wed, 21 Dec 2011 21:36:59 +0000

Detecting Medicare fraud is more easily done when recipients are proactive about trying to avoid it. One of the best ways to do that is to pay close attention to the statements that are sent by Medicare every few months. The following excerpt from the Illinois Senior Medicare Patrol Program highlights some of the red flags that may pop up if someone is using your account number.

We read our credit card statements to make sure that no one bills our credit card fraudulently. We also need to read our Medicare statements to make sure that no one steals our benefits! If you have Medicare, you should receive a statement four times a year. Read those statements carefully to make sure that everything is correct. Watch for charges for services or supplies that you did not receive, services that were not ordered by your doctor, or other errors. If you would like to receive your Medicare Summary Notice in a language other than English, call 1-800-Medicare to request that they send you a statement in your own language.

For specific questions about your claims, medical records, or expenses, visit MyMedicare.gov, or call 1-800-MEDICARE.

OIG Seeks Public Assistance to Capture Health Care Fugitives

awinder — Tue, 06 Dec 2011 21:16:09 +0000

The U.S. Department of Health and Human Service’s Office of Inspector General (OIG) is currently looking for more than a hundred healthcare fugitives who are charged with defrauding Medicare and Medicaid out of 400 million dollars. OIG’s most wanted fugitives website highlights the top criminals on its list. Visitors to the website can view photos and read descriptions and statistics about each criminal. Gerald T. Roy, Deputy Inspector General for Investigations encourages consumers to visit the website often, especially if there’s concern about a scam in your area. He says catching these criminals helps protect tax payer dollars and programs meant to help those in need.

Find more information here:
http://oig.hhs.gov/fraud/fugitives/index.asp

You can also watch Mr. Roy speak about the website in this new video:

Webinar on Medicare Fraud Now Available

Angela Wilson — Wed, 30 Nov 2011 13:40:16 +0000

This month, GeorgiaCare offered a free webinar to seniors with questions about Medicare. The show took live calls through a phone bank, and qualified panelists answered questions about Medicare and Medicaid services, Medicare fraud and other scams.

While some answers may be Georgia-specific, the webinar offers excellent information for anyone with similar questions.

The broadcast was recorded and is available here:

http://www.gpb.org/georgia-cares

The broadcast includes panelists from the Department of Human Services, Division of Aging Services, Social Security Administration and more.

Alabama Firm Charged with Fraud

Angela Wilson — Fri, 30 Sep 2011 14:52:19 +0000

The feds have launched a Medicare Fraud case against Alabama-based SouthernCare.

Just two years ago, SouthernCare settled another fraud suit in its home state for nearly $25 million. This time, a former employee filed the suit using the False Claims Act after federal officials refused to pursue charges, Madison.com reports. From the story:

Karina Christensen of Waunakee, former clinical director of SouthernCare’s Madison office, filed the new suit in February in U.S. District Court in Madison. It was unsealed Wednesday after the federal government declined to intervene.

Christensen alleges that SouthernCare charged Medicare for care the company provided to patients who didn’t have terminal illnesses. Medicare, the main payer for hospice care, or comfort care preceding death, requires patients to have six months or less to live as determined by a doctor. …

Christensen claims her supervisors encouraged enrollment of patients who weren’t terminally ill and dismissed her complaints that the practice was illegal. She was fired shortly after sending the board of directors and the regional director a letter about her concerns in August 2010, the suit says.

Read more: http://host.madison.com/news/local/health_med_fit/article_bbf705d0-df1e-11e0-b333-001cc4c03286.html#ixzz1ZOQi5AHi

Find out more about the False Claims Act in a special Wisconsin SMP training podcast! Read the post and listen to an interview with Elizabeth Conrad here.

Task Force Nabs 91 in Multi-Million Dollar Medicare Fraud Case

Angela Wilson — Thu, 08 Sep 2011 14:15:57 +0000

The Medicare Fraud Strike Force struck hard last week week in eight American cities, arresting 91 people for bilking the federal government for more than $295 million.

It was the largest dollar amount associated with a takedown in the history of the task force.

According to a statement from the Department of Health and Human Services:

As part of a coordinated action, 70 individuals were charged by Strike Force prosecutors in indictments unsealed yesterday and today in six cities alleging a variety of Medicare fraud schemes involving approximately $263.6 million in false billings. As part of takedown operations last week, 18 additional defendants were charged in Detroit and one defendant was charged in Miami in cases unsealed on Sept. 1, 2011, for their alleged roles in Medicare fraud schemes involving approximately $29.4 million in fraudulent claims. Additionally, two individuals are scheduled to appear in court today on charges filed on Aug. 24, 2011, for their roles in a separate $2 million health care fraud scheme.

Read the full statement.

Prepare for Medicare Part D Enrollment

Angela Wilson — Sun, 28 Aug 2011 18:47:05 +0000

The time to join or change Medicare Part D plans is near.

This year’s Medicare Part D annual enrollment period is scheduled from Oct. 15 through Dec. 7.

It is only during this time that beneficiaries can switch, join or drop plans.

New plans go into effect on Jan. 1, 2012.

For more information on how to select a plan, visit: www.medicare.gov or make an appointment with your county Elderly Benefit Specialist.

SMP volunteers are excellent candidates for assisting Elderly Benefit Specialists during the busy annual enrollment period. If you are an SMP volunteer, please contact your county Elderly Benefit Specialist to see how you can help. If you want to become a Wisconsin SMP volunteer, click here.

Find out more about this and other issues in the August Fraud Alert newsletter.

Wisconsin SMP Saves Family Thousands

Angela Wilson — Thu, 04 Aug 2011 11:57:28 +0000

Excerpt from the July Fraud Alert newsletter. Download the full newsletter here.

An adult daughter received a suspicious bill ($7,000) from a hospice provider, located in another state, for hospice services her mother received while residing in a Medicare certified skilled nursing facility.

The bill arrived approximately six months after her mother passed away. The daughter knew that her mother could not have owed the hospice provider money because her mother’s health coverage included Medicare and Medicaid.

When the daughter’s questions regarding her mother’s alleged bill could not be successfully resolved with the hospice provider, she contacted Wisconsin SMP and insisted that the matter be pursued further. What if this wasn’t a simple billing error? Were other people receiving similar bills? The adult daughter suspected that had she been less involved with her mother’s care, she might have gone ahead and paid the bill (as executor of her mother’s estate) and that the provider could probably have made a profitable sum of money.

Thanks to the adult daughter’s intervention, in this case Wisconsin SMP was able to save her from paying $7,000.

How You Can Help

Please contact Elizabeth Conrad. Director of the Wisconsin SMP project if you suspect a billing situation that may be fraud, waste, or abuse in the Medicare and Medicaid programs. She can be reached via email at econrad@cwag.org or by phone at 800-488-2596 extension 317.

Share Your Experiences

Want to get the word out about consumer scams in your area? Tell us about your experiences so we can include them in our monthly Wisconsin SMP Fraud Alert newsletter. The Fraud Alert not only warns the public of current and continuing scams, it also features articles on topics such as credit counseling and the False Claims Act. It is widely circulated in both hardcopy and electronic formats.