House Call

69510709 - interior armchair for client to room in hospital

Back in the early to mid-20th century, house calls by doctors were considered a common practice, especially in rural areas. Today, house calls are usually reserved for those who are unable to get to the doctor’s office and are performed by home health care service companies that dispatch medical personnel to check on patients. A press release issued by The Department of Justice describes how a former Detroit-area physician participated in a fraudulent scheme to bill Medicare for more than $11.5 million in house call services.

The press release states that over approximately a two-and-a-half year period, the 60-year-old former physician claimed to be licensed, even though his medical license had been revoked. (That’s a scary thought.) During this time, he purportedly provided physician home services to Medicare beneficiaries, charging for services he did not provide. He operated his billing scheme out of a medical practice that was owned by an alleged co-conspirator. The fraudulent physician prepared medical documentation allegedly signed by licensed doctors, who did not perform the claimed services. (Let’s hope the Medicare Strike Force will go after those doctors too.) Over nearly four-and-a-half years, the unlicensed doctor caused false claims of approximately $1.1 million to be submitted.

The fraudulent doctor pleaded guilty to one count of conspiracy to commit health care fraud. He faces up to 10 years in prison plus a $250,000 fine.

This doctor’s career is definitely over whether licensed or not. It’s a given that he will not be making any more house calls as part of his profession. (The only house he will be visiting is the Big House, where he will be staying for quite an extended amount of time.)

Source: Today’s ”Fraud of the Day” is based on a press release titled, ”Physician Pleads Guilty for Role in Detroit-Area Medicare Fraud Scheme,” issued by The United States Department of Justice on March 6, 2014.

DETROIT – A former Detroit-area physician pleaded guilty today for his role in an $11.5 million health care fraud scheme.

Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, U.S. Attorney Barbara L. McQuade of the Eastern District of Michigan, Special Agent in Charge Paul M. Abbate of the FBI’s Detroit Field Office and Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) Chicago Regional Office made the announcement.

Read More

Previous articleAccess Denied
Next articleLiving Large
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.