At Home with Fraud

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To say that someone is “at home” with doing something means that they are comfortable with their actions. Today ‘s “Fraud of the Day” covers four New Orleans doctors and two others who worked for a home health care company. They were “at home” with fraudulently billing Medicare for medically unnecessary services.

Six employees of the home healthcare services company were involved in a jury trial that lasted for a month. Prosecutors claimed that they were all involved with a scheme to routinely falsify diagnoses with the purpose of inflating reimbursements from the government healthcare program. The defendants falsified medical records that supported the medically unnecessary home health services, netting more than $13.6 million in fraudulent reimbursements.

Delving a little deeper into the case, four of the defendants were considered “home doctors.” They were responsible for ordering home healthcare services for Medicare beneficiaries who did not have a legitimate reason for needing the bogus medical orders. (Three of the doctors received monthly payments from the company for their role as a “medical consultant” or “director” even though no consultant services were provided.)

The wife of one of the doctors participating in the scheme was hired by the company to fraudulently certify documents, receiving an “inflated” salary for her criminal efforts of billing Medicare on behalf of the home health services company. Another defendant was responsible for scheduling doctor visits, knowing that the patient referral did not come from the patient ‘s own doctor.

The trial ‘s outcome included convictions for healthcare fraud, conspiracy to commit healthcare fraud and to defraud the United States and to receive and pay healthcare kickbacks, and obstruction of a federal audit. The ages of the guilty ranged from 29 to 71. The defendants are facing from 15 to 170 years in prison and each face a maximum fine of up to $250,000 on each count. (The woman who owned the home healthcare company previously pleaded guilty to her role along with 18 other individuals or companies who were involved in the scheme.)

It looks like these fraudsters, who were “at home” with fraudulently billing Medicare, will probably be heading to a new home at the big house when sentenced. (I’m guessing they won’t be feeling quite as “at home” there.)

Source: Today’s “Fraud of the Day” is based on an article entitled, “4 New Orleans doctors, 2 others convicted in $13.6 million Medicare fraud scheme,” published by The Times-Picayune on May 10, 2017.

A jury convicted four New Orleans doctors and two others on Tuesday (May 9) in federal court for participating in a Medicare fraud scheme prosecutors say netted more than $13.6 million in fraudulent Medicare reimbursements.

The six defendants, all from the New Orleans area, worked for or with Abide Home Care Services, which federal prosecutors said routinely falsified diagnoses so Medicare reimbursements were inflated. Abide also falsified medical records that supported medically unnecessary home health services, prosecutors said. The company was owned by New Orleans businesswoman Lisa Crinel, who pleaded guilty to her role in the scheme in 2015. Eighteen other individuals or companies also previously pleaded guilty related to the scheme.

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Larry Benson
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.