Physical Therapy, Occupational Fraud

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The owners and operators of medical clinics should be in business to provide essential treatments and services to people who need them. Unfortunately, according to a story in Capital New York, one woman who owned two medical clinics pleaded guilty on Monday, October 26, to defrauding Medicare and Medicaid of more than $55 million.

The article reports the fraudster provided patients with unnecessary treatments and then billed government health programs for reimbursement. (Therapeutic treatments are designed to help patients productively address problematic aspects of their day-to-day lives, but I doubt this fraudster could’ve overcome her rampant appetite for taxpayers’ money through therapy.)This fraudster’s arrest, and the discovery of her scheme, were part of one of the most extensive health care fraud discoveries and prosecutions in U.S. history. According to the story, the U.S. Attorney General’s Office has already secured 10 additional guilty pleas related to this case.

One reason that the Attorney General’s Office has secured so many additional guilty pleas is because a fraud conspiracy of this scale required co-conspirators. The story explains that the owner of the medical clinic offered kickbacks to Medicare and Medicaid patients who received medically unnecessary occupational and physical therapy treatments. Making matters worse, the treatments were performed by unlicensed professionals.

The story states that this case was investigated jointly by the U.S. Department of Health and Human Services and the New York State Office of the Medicaid Inspector General. The sentencing date for the fraudster who owned and operated the medical clinics has yet to be set. Nonetheless, as part of her guilty plea, this fraudster will pay nearly $30 million in restitution to the federal government and the state of New York.

Physical or occupational therapy can be medically necessary to treat injuries, but the fact that these patients didn’t need any treatment only adds insult to the injury that taxpayers experienced. Kudos to the investigators who brought down this scheme. Hopefully, would-be fraudsters will see that in the end it doesn’t pay to defraud the government and rethink their intended schemes.

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Clinic owner pleads guilty in $55 million fraud,” written by Dan Goldberg and published by Capital New York on October 26, 2015.

A 46-year-old woman who owned two Brooklyn medical clinics pleaded guilty Monday to defrauding Medicare and Medicaid out of $55 million, according to a press release from the U.S. Attorney’s office.

Valentina Kovalienko will pay back nearly $30 million after admitting she was part of a scheme that paid patients to undergo medically unnecessary physical and occupational therapy, which was performed by unlicensed professionals.

The services were billed to Medicare and Medicaid and the patients would receive a kickback, the release said.

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Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.