Sounds Like Fraud

Happy mature doctor assisting senior man with resistance band in rehab fitness center

A Garland, Texas healthcare administrator recently pleaded guilty to her role in a $5.1 million Medicare fraud conspiracy. The conspiracy stemmed from a family bent on bilking Medicare through the submission of false claims for hearing related services.

According to documents filed in the case, the healthcare administrator’s husband owned and operated the company, which provided hearing-related services to senior citizens. The family-run business also employed the healthcare administrator’s 72-year-old mother, who managed day-to-day operations and marketed to nursing homes. (Sounds like fraud definitely runs in the family.)

The hearing-service company enrolled as a Medicare provider in August 2011. Under the family’s direction, the company then proceeded to bill Medicare for procedures performed on elderly nursing home patients. (The company allegedly sold nursing homes on the concept of comprehensive exams, performed by qualified ear, nose and throat doctors.)

However, the company conspired to perform exams on literally every patient in the nursing homes they visited. (This was regardless of whether the procedures were necessary or not and whether the patients were even conscious at the time of the exam.) Physicians reportedly saw 100 patients a day on a regular basis, usually spending as little as five minutes or less with them. The family members who ran the company then directed employees to submit bills to Medicare for face-to-face visits that were billed as 35-minute sessions. (There’s a discrepancy of 30 minutes there. When you multiply that by 100 patients, costs add up fast.)

Two physicians who were employed by the fraudulent business described the patient procedures as, “cursory exams that had no medical value.” (Physicians would perform tasks as trivial as checking for ear wax and ordering ear wax cleanings, even if the patient did not need or consent to the cleanings.) These unnecessary and sometimes entirely fictional services were then fraudulently billed to Medicare. Some of the patients listed in the Medicare claims had actually refused services. (However, such trivialities were not about to stand in between this family and illicit profit.)

The Texas family members’ indictment was part of a nationwide Medicare fraud crackdown that identified over $900 million in scammed Medicare funds. As a result of the family’s fraud conspiracy, the FBI seized assets from the family including their $400,000 home in Garland, Texas, a Mercedes-Benz and a Maserati. (Ear wax cleanings must come with one heck of a markup!)

The 51-year-old healthcare administrator now faces up to five years in federal prison, in addition to a $250,000 fine and possible restitution payment. Her mother is awaiting sentencing, while her husband is awaiting his trial.  (I’m guessing these three will be listening loud and clear to what the judge will have to say about their senseless crime.)

Today’s “Fraud of the Day” is based on a press release entitled, “Garland Woman Admits Role in Health Care Fraud Conspiracy,” published by the United States Attorney’s Office, Northern District of Texas on September 19, 2017.

DALLASTexas — Latecia P. Hill, 51, of Garland, Texas, pleaded guilty today, before U.S. Magistrate Judge Paul D. Stickney, to one count of conspiracy to commit health care fraud stemming from a scheme to defraud Medicare through the submission of false claims for hearing related services. The announcement was made today by U.S. Attorney John Parker of the Northern District of Texas.

Hill faces a maximum penalty not to exceed 5 years in federal prison, a $250,000 fine, and may be ordered to pay restitution. Hill will remain on bond pending sentencing.

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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.