MEDICARE FRAUD & DOCTORS

This story announcing that 89 people were charged with Medicare fraud, including 14 doctors & nurses, led me to wonder how often doctors are involved in these scams.  I used LexisNexis to search for "doctors" and "Medicare fraud" over the last year and by omitting duplicate stories, there were 1,551 results.  I decided to just post the arrested, charged or convicted over the last month.

Here are the results:

(1) Man gets 5 years in $13.8M Medicare fraud case

May 13, 2013 Monday 7:05 PM GMT 

SECTION: STATE AND REGIONAL

LENGTH: 106 words

DATELINE: DETROIT

Federal prosecutors say the owner of a Detroit-area home health care agency owner has been sentenced to 5 years in Detroit for his role in a $13.8 million medical fraud conspiracy.

The U.S. Justice Department says that Rehan Kahn was sentenced Monday in Detroit.

The department says Khan was an owner of Moonlite Home Care Inc. and worked as a physical therapy assistant for several home health agencies in the Detroit area. Prosecutors say Khan paid doctors to refer patients for home health care services that were either unnecessary or weren't provided.

They say he was responsible for making $1.77 million in false billings to Medicare.

(2) May 7, 2013 Tuesday 11:09 PM GMT
Doctor sentenced over false Medicare billing

SECTION: STATE AND REGIONAL

LENGTH: 138 words

DATELINE: DENVER

A doctor accused of submitting false bills for reimbursement from Colorado's Medicaid program and Medicare has been ordered to serve 200 hours of public service, plus two years of supervised probation.

Colorado Attorney General John Suthers said Tuesday that Tatyana Datkhaeva pleaded guilty in Denver District Court to felony theft and misdemeanor theft. She received a deferred judgment on the felony count.

In addition to being ordered to serve probation and perform public service, she must pay more than $44,000 in restitution. She also agreed to pay a fine of more than $33,000 to the Colorado Medicaid program.

Suthers says she performed cold laser therapy on patients but instead claimed to have rendered physical therapy services. Physical therapy is covered for Medicaid and Medicare recipients, but cold laser therapy isn't.

(3)  April 24, 2013 Wednesday
Washington: Mechanicsburg Doctor and Owner of Two Medical Facilities Pleads Guilty in Federal Court

LENGTH: 486 words

DATELINE: Washington

US Federal Bureau of Investigation, The Government of USA has issued the following news release:

The United States Attorney’s Office for the Middle District of Pennsylvania announced that a Mechanicsburg doctor and owner of two Central Pennsylvania medical facilities pleaded guilty today in federal court in Harrisburg before U.S. District Judge Christopher C. Conner.

According to United States Attorney Peter J. Smith, Dr. Timothy Clark, age 44, is a medical doctor and pulmonologist and the sole owner of Central Pennsylvania Pulmonary Associates (CPPA) and Sleep Disorder Centers of Central Pennsylvania. In June 2012 and again in July, Clark was indicted by a federal grand jury in Harrisburg in separate indictments.

In June 2012, Clark was indicted on charges that from July 2010 through December 2011, as the owner of CPPA and the trustee of the CPPA employee 401(k) plan, he withheld employee 401(k) contributions and failed to deposit the withheld funds into their 401(k) plan. Clark instead maintained the employee 401(k) contributions in bank accounts he controlled. Clark’s employees lost approximately $25,000 of their retirement funds.

In July 2012, Clark was indicted on charges that from December 2007 through September 26, 2008, Clark, who provided critical care services to patients of Holy Spirit Hospital, intentionally inflated the amount of time the health care providers he employed spent with each patient, thereby fraudulently inflating the health insurance claims Clark submitted to Medicare, Highmark Inc., and Capital Blue Cross. The dollar amount of the fraudulent claims exceeded $500,000. In the indictment’s six money laundering counts, Clark was charged with transferring approximately $103,000 obtained through the health care fraud to CPPA payroll and money market accounts.

(4) April 24, 2013 Wednesday 12:20 PM GMT
Dallas-area doctor charged with health care fraud

SECTION: STATE AND REGIONAL

LENGTH: 139 words

DATELINE: TERRELL Texas

A North Texas physician who ran a now-closed hospital near Dallas has been indicted in a more than $1 million health care fraud investigation.

Prosecutors say Dr. Tariq Mahmood of Cedar Hill has been charged with conspiracy to commit health care fraud and seven counts of health care fraud. The cases involve claims to Medicare and Medicaid since 2010.

(5) April 23, 2013 Tuesday 12:47 PM GMT
Alabama doctor sentenced to prison in fraud case

SECTION: STATE AND REGIONAL

LENGTH: 211 words

DATELINE: FLORENCE Ala.

An Alabama physician will spend a year and a day in federal prison after prosecutors say she bilked nearly $1 million from Medicare and BlueCross BlueShield of Alabama.

Authorities say the health care fraud case involved non-reimbursable cosmetic skin treatments.

The doctor, 55-year-old Diana McCutcheon of Killen, had been charged with health care fraud and wire fraud. She was sentenced to the prison term on Monday, The TimesDaily reported ( http://bit.ly/128nJyh).

U.S. District Judge Inge Johnson also ordered McCutcheon to pay restitution of $990,389 to BlueCross BlueShield and Medicare. She also must pay the same amount to the government.

"She was hoping for more consideration from the judge in terms of our request for probation," said Huntsville attorney Robert Tuten, who represents McCutcheon. "We were hopeful for probation, but we knew it was a long shot given the amount of loss."

She pleaded guilty to the charges in November.

"This defendant carried on a scheme for several years, fraudulently billing private and public insurance plans for payments she was not entitled to," U.S, Attorney Joyce Vance said in a statement. "That kind of fraud drives up health care and insurance costs for everyone."

(6) April 18, 2013 Thursday
LAKE CHARLES DOCTOR PLEADS GUILTY TO HEALTH CARE FRAUD

BYLINE: States News Service

LENGTH: 288 words

DATELINE: LAFAYETTE, La.

The following information was released by the New Orleans Division of the Federal Bureau of Investigation:

United States Attorney Stephanie A. Finley announced today that Dr. Lynn E. Foret, 63, of Lake Charles, Louisiana, pleaded guilty before U.S. District Court Judge Richard T. Haik to defrauding Medicare, Medicaid, and private insurance companies of close to $1 million.

According to the bill of information, from 2003 to 2009, Foret injected his patients knees with a steroid solution while falsely billing and receiving payments from Medicare, Medicaid, and private insurance companies for a more costly drug called Hyalgan. During the time period outlined in the bill of information, he received reimbursements totaling $948,249.11. Foret is a Lake Charles medical doctor who specialized in orthopedic surgery since 1976. He closed his practice in December 2012.

Various types of steroids are often used to treat osteoarthritis of the knee. Hyalgan is another more costly type of medication that is used to treat osteoarthritis. It contains a natural substance called Hyaluronate, which is normally found in the fluid that lubricates and cushions knee joints and is injected directly into a patients knee to relieve inflammation.

Foret faces a maximum penalty of 10 years in prison, a $250,000 fine, restitution, and three years of supervised release for the count of heath care fraud. A sentencing date has not been set.

The Medicaid Fraud Control Unit (MFCU) of the Louisiana State Attorney Generals Office, FBI, U.S. Food and Drug Administration, and the Department of Health and Human Services-Office of Inspector General (OIG) conducted the investigation. Assistant U.S. Attorney Kelly P. Uebinger is prosecuting the case.

(7) April 18, 2013
Four charged in alleged medical fraud that gave patients bogus lab tests

BYLINE: Peter J. Sampson

SECTION: A; Pg. 3

LENGTH: 1062 words

WAYNE - Scores of North Jersey patients were betrayed by their doctors and left with bogus diagnoses in their medical files as a result of a widespread cash-for-referrals scheme that generated tens of millions of dollars in profits for a Parsippany-based diagnostic lab.

The long-running scheme involving "numerous" doctors in New Jersey bilked millions of dollars from Medicare and private health insurers, betrayed the trust of patients and could lead to future problems for patients whose medical records were doctored with fabricated diagnosis codes to justify ordering unnecessary blood tests, said U.S. Attorney Paul J. Fishman, who announced charges on April 9 against four people.

Among them was Dr. Frank Santangelo, an internist with offices in Wayne and Montville, who allegedly received more than $700,000 in bribes for referring at least $4.2 million in blood tests to Biodiagnostic Laboratory Services LLC. Santangelo, 43, of Boonton, also was charged with using the mails and facilities in interstate commerce to promote commercial bribery.

(8) April 17, 2013 Wednesday
Washington: Chicago Sacred Heart Hospital Owner, Executive, and Four Doctors Arrested in Alleged Medicare Referral Kickback Conspiracy

LENGTH: 1634 words

DATELINE: Washington

US Federal Bureau of Investigation, The Government of USA has issued the following news release:

The owner and another senior executive of Sacred Heart Hospital and four physicians affiliated with the west side facility were arrested today for allegedly conspiring to pay and receive illegal kickbacks, including more than $225,000 in cash, along with other forms of payment, in exchange for the referral of patients insured by Medicare and Medicaid to the hospital, announced U.S. Attorney for the Northern District of Illinois Gary S. Shapiro.

Agents from the FBI and the U.S. Department of Health and Human Services Office of Inspector General today also began executing search and seizure warrants in connection with an ongoing investigation of alleged Medicare and Medicaid fraud schemes at the hospital involving emergency room evaluation, testing, and observation services that were not medically necessary, as well as medically unnecessary sedation, intubation, and tracheotomy procedures performed on patients. Approximately $2 million in Medicare reimbursement payments was seized today from various bank accounts.

Arrested were Edward J. Novak, 58, of Park Ridge, Sacred Heart’s owner and chief executive officer since the late 1990s; Roy M. Payawal, 64, of Burr Ridge, executive vice president and chief financial officer since the early 2000s; and Drs. Venkateswara R. “V.R.” Kuchipudi, 66, of Oak Brook, Percy Conrad May, Jr., 75, of Chicago, Subir Maitra, 73, of Chicago, and Shanin Moshiri, 57, of Chicago.

Sacred Heart Hospital is a 119-bed acute care facility located at 3240 West Franklin Blvd. in Chicago. Approximately 40 in-patients were in the hospital this morning, and representatives of the HHS Centers for Medicare and Medicaid Services (CMS) were on site and coordinating with the Illinois Department of Healthcare and Family Services to ensure continuity of patient care.

“These charges and the affidavit’s other allegations outline a kickback conspiracy to bribe doctors to refer patients to Sacred Heart where they would be treated in in an environment in which the quality of care and appropriate medical analysis were less important than maximizing the numbers of patients funneled into the hospital,” said Gary S. Shapiro, United States Attorney for the Northern District of Illinois.

(9) April 16, 2013 Tuesday
SAN FERNANDO VALLEY DOCTOR WHO PLED GUILTY IN $3 MILLION MEDICARE FRAUD CASE SENTENCED TO MORE THAN THREE YEARS IN FEDERAL PRISON

BYLINE: States News Service

LENGTH: 463 words

DATELINE: LOS ANGELES, Calif.

The following information was released by the Los Angeles Division of the Federal Bureau of Investigation:

A medical doctor who owns a cosmetic medicine clinic in the Winnetka district of the San Fernando Valley has been sentenced to 42 months in federal prison for bilking Medicare out of more than $3 million by submitting bills for procedures he never performed.

Pezhman Ebrahimzadeh, who uses the name Pez Abrahams, 50, of Calabasas, received the three-and-a-half-year sentence yesterday from United States District Judge George H. Wu.

In addition to the prison term, Judge Wu ordered Ebrahimzadeh to pay $3,184,000 in restitution, most of which is to be paid to the Medicare program.