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Hold The Moles

Healthcare-10
Senior Director of Strategic Alliances
LexisNexis Risk Solutions - Government

One might wonder if Medicare provider participation agreements, made and signed by government officials, are designed to promote Medicare fraud. John Greager owned and operated Cancer Therapy Associates, in Lombard, Ill. Business was good, but Greager wanted more. And he wasn’t going to do it by taking in more patients. From 2015 to 2021, Greager fraudulently obtained approximately $4.1 million from Medicare and Blue Cross Blue Shield of Illinois by submitting claims that falsely represented that certain health care services, in particular mole removal procedures.

Greager submitted claims to Medicare and Blue Cross Blue Shield of Illinois falsely stating that mole-removal procedures had been provided to patients on multiple dates.  Greager knew that those services were not provided as billed.  Greager had removed multiple moles on a single date, but the procedures were billed as though they were removed on separate dates to maximize reimbursement from Medicare. Why? Because Medicare pays more for moles removed on separate dates than multiple moles on a single date.  Medicare and Blue Cross Blue Shield ultimately paid Greager approximately $1.7.

To conceal his fraudulent conduct, Greager stored moles onsite at his office and delayed sending them for pathology testing.  As a result, the pathology reports made it appear as though Greager had removed the moles on separate dates.  Greager’s conduct delayed critical testing on moles that he removed for serious illnesses, including cancer.  Greager also created fake patient charts, including pre-operative and post-operative notes that indicated he performed mole-removal procedures on dates when he was not even in Illinois.  Medicare conducted an audit of Greager’s patient charts, prompting Greager to instruct his staff to create false records to hide the fact that he committed health care fraud. Because even if the contracted agreement seems ludicrous, it is still fraud.

Kudos to the Department of Health and Human Services for conducting the audit.

Today’s Fraud Of The Day is based on article “Mole-removal scheme nets Lombard doctor 6 months in prison” published by the Daily Herald on June 16, 2023

A former Lombard doctor will spend six months in federal prison after pleading guilty to health care fraud stemming from a mole-removal scheme he concocted to collect more money from an insurance company and Medicare.

Prosecutors said John A. Greager II, 75, of Hinsdale, operated Cancer Therapy Associates in Lombard from 2015 to 2021 where he would routinely bill Blue Cross Blue Shield of Illinois and Medicare for removing moles on multiple visits when in actuality they were all done in one visit.

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