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Healthcare-Medicare-15
Senior Director of Strategic Alliances
LexisNexis Risk Solutions - Government

What does Durable Medical Equipment (the equipment ordered by a health care provider for the patients everyday use such as oxygen equipment, wheelchairs and crutches) and Genetic Testing (a medical test that determines a genetic condition or disorder) have in common? In this case? Fraud.

On June 21, 2022, Dr. Patrick Finney admitted guilt in court to violating the False Claims Act, knowingly using false records and statements to get payments from Medicare and conspiring to defraud Medicare by causing the submission and payment of false claims. Those are fancy words that mean Dr. Finney stole the identities of Medicare patients and wrote prescription orders for DME and DME and genetic testing items and services without ever meeting or talking to these patients.

According to prosecutors, Finney entered into financial arrangements to provide clients of physician staffing firm Barton Associates with telehealth services related to the referral of Medicare patients for durable medical equipment and genetic testing items. Finney received illegal compensation from Barton Associates and its telehealth clients in exchange for referring Medicare patients for those services. Prosecutors say that that arrangement is a violation of the Anti-Kickback Statute.

Finney admitted that he knowingly submitted or conspired to submit more than $3 million in false claims to Medicare. According to the False Claims act he’s liable to the United States for over $11 million because the act allows for damages totaling three times the amount of money the government lost, plus penalties. But a stipulation and order Finney signed admitting to the Medicare fraud allegations allows him to fulfill his obligation by paying $561,800. Why is the restitution less than the amount defrauded? There is no answer to that.

Commendable job by Health and Human Services Office of Inspector General for their outstanding work in this case.

Today’s Fraud of the Day is based on an article “Paducah doctor to pay $561,800 for defrauding Medicare” published by Sun Staff on June 23, 2022

A local doctor has agreed to pay $561,800 to resolve allegations of knowingly submitting fraudulent or false claims to Medicare, using and making false records and statements to obtain payment and conspiring to defraud Medicare by causing the submission and payment of false or fraudulent claims, according to a U.S. Department of Justice news release.

According to the government’s complaint, Patrick C. Finney, in violation of the False Claims Act, from at least Nov. 16, 2017, through Aug. 28, 2020, participated in and accepted illegal kickbacks in exchange for ordering durable medical equipment for 1233 Medicare beneficiaries and genetic testing for 386 Medicare beneficiaries, defrauding Medicare for $3.67 million.

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