Medicare Fraud Strike Force Charges 111 Individuals for More Than $225 Million in Fal

Home Health Columnist / Guide · Oct 6, 2012

“Over the last two years our joint efforts have more than quadrupled the number of anti-fraud Strike Force teams operating in fraud hot spots around the country from two to nine -- with the latest additions Chicago and Dallas -- bringing hundreds of charges against criminals who had billed Medicare for hundreds of millions of dollars. Last year alone, our partnership recovered a record $4 billion on behalf of taxpayers. From 2008-2010, every dollar the Federal Government spent under its Health Care Fraud and Abuse Control programs averaged a return on investment of $6.80,” said HHS Secretary Sebelius.
The defendants charged today are accused of various health care fraud-related crimes, including conspiracy to defraud the Medicare program, criminal false claims, violations of the anti-kickback statutes, money laundering and aggravated identity theft. The charges are based on a variety of alleged fraud schemes involving various medical treatments and services such as home health care, physical and occupational therapy, nerve conduction tests and durable medical equipment.

The Medicare Fraud Strike Force was beefed up directly as a result of the passage of that pesky Affordable Care Act, aka Obama Care-- another good thing resulting from this legislation.

New Resources to Fight Fraud: The Affordable Care Act provides an additional $350 million over the next ten years to help fight fraud through the Health Care Fraud and Abuse Control Account (HCFAC) from FY 2011 through 2020. The Act also allows these funds to support the hiring of new officials and agents that can help prevent and identify fraud.
The Affordable Care Act: New Tools to Fight Fraud, Strengthen Medicare and Protect Taxpayer Dollars

Home Health Columnist / Guide · Oct 6, 2012

Dallas Doctor Arrested for Alleged Role in Nearly $375 Million Home Health Care Fraud Scheme

Office Manager for Doctor and Five Owners of Dallas-Area Home Health Agencies Also Arrested

Average physician signs maximum ~ 100 or fewer Home Health Plan of Care Certifications/year in agency where I manage Central Intake while this doctor signed off 5,000!!! Karen

According to the indictment, Dr. Roy owned and operated Medistat Group Associates P.A. in the Dallas area. Medistat was an association of health care providers that primarily provided home health certifications and performed patient home visits. Dr. Roy allegedly certified or directed the certification of more than 11,000 individual patients from more than 500 HHAs for home health services during the past five years. Between January 2006 and November 2011, Medistat certified more Medicare beneficiaries for home health services and had more purported patients than any other medical practice in the United States. These certifications allegedly resulted in more than $350 million being fraudulently billed to Medicare and more than $24 million being fraudulently billed to Medicaid by Medistat and HHAs. ...
“Using sophisticated data analysis we can now target suspicious billing spikes,” said HHS Inspector General Levinson. “In this case, our analysts discovered that in 2010, while 99 percent of physicians who certified patients for home health signed off on 104 or fewer people – Dr. Roy certified more than 5,000.”

tyvin, BSN, RN · Oct 6, 2012

The strike force was formed and started in March of 2007. The cases that are being talked about in the 1 year old article (in your first post) had their inception long before the ACA put that little bit of money their way (it really is a small amount to last for the next 10 years). There's no need to defend the ACA...it's law already.

Dr.Roy; they were watching him hang himself for a long time. These types of cases take years to set up and execute. That doctor's hand has got to be tired.

Each administration builds off the next...it's the American way.

allnurses Guide · Oct 22, 2013

Most recent settlements and convictions.

Stopping these criminals saves medicare millions every year.

October 21, 2013; U.S. Attorney; Eastern District of Michigan Kmart Corporation to Pay U.S. More Than $2.5 Million to Settle False Claims Act Allegations for Partially Filled Prescriptions

Kmart Corporation has agreed to pay the United States and 32 participating states a total of $2,550,000 to settle allegations of false prescription claims by its national pharmacy centers to government health insurance programs, U.S. Attorney Barbara L. McQuade announced today.

October 21, 2013; U.S. Attorney; Western District of Kentucky Nelson County Drug Store Owner Sentenced To 27 Months for Health Care Fraud and Wire Fraud

LOUISVILLE, Ky. - The owner of Crume Drug Store, located in Nelson County, Kentucky, was sentenced in federal court October 1, 2013, by Chief Judge Joseph H. McKinley, Jr., to 27 months in prison, followed by a two year term of supervised release, and was ordered to pay $242,963.04 in restitution, announced David J. Hale, United States Attorney for the Western District of Kentucky.

October 18, 2013; U.S. Attorney; Middle District of Florida Disbarred Attorney and Her Ex-Husband Sentenced To Prison for Stealing $2.8 Million from Clients in Medicaid Planning Fraud Scheme

Orlando, FL - Chief U.S. District Judge Anne Conway sentenced Ross Littlefield (48, Kissimmee) and Linda Littlefield (41, Kissimmee) yesterday for money laundering. Ross Littlefield was sentenced to four years in federal prison. Linda Littlefield was sentenced to five years in prison. As part of their sentence, the court also entered a restitution order in the amount of $2,888,418.05 and a money judgment in the amount of $155,739.93. The Littlefields pleaded guilty on June 11, 2013.

October 18, 2013; U.S. Department of Justice Operators of Michigan Adult Day Care Centers Convicted in $3.2 Million Medicare Fraud Scheme

A federal jury in Detroit today convicted the owner and the program coordinator of two Flint, Mich., adult day care centers for their participation in a $3.2 million Medicare fraud scheme.

October 18, 2013; U.S. Attorney; District of Connecticut Greenwich Doctor Pays $300,000 to Settle Allegations under The False Claims Act

Deirdre M. Daly, Acting United States Attorney for the District of Connecticut, today announced that JUN XU, M.D., and his professional corporation, Rehabilitation Medicine And Acupuncture Center M.D., LLC., of Riverside, Conn., have entered into a civil settlement with the government in which they will pay $300,000 to resolve allegations that XU violated the False Claims Act.

October 18, 2013; U.S. Attorney; District of Kansas Indictment: Wichita Chiropractor Defrauded Health Insurers

Wichita, KA - A federal indictment charging a Wichita chiropractor in a $1.3 million health care fraud scheme was unsealed today, U.S. Attorney Barry Grissom. The chiropractor surrendered his license today.

October 17, 2013; U.S. Attorney; Southern District of Illinois Cahokia Woman Pleads Guilty To Health Care Fraud

Stephen R. Wigginton, United States Attorney for the Southern District of Illinois, announced today that on October 16, 2013, Karashia A. Tabbs, 45, of Cahokia, Illinois, pled guilty to a one-count indictment charging that she engaged in a scheme to commit health care fraud. Sentencing has been set for January 23, 2014, in United States District Court in East St. Louis, Illinois. Tabbs will face up to 10 years in prison, a fine of up to $250,000, and up to 3 years of supervised release.

October 17, 2013; U.S. Department of Justice Boston Scientific and Subsidiaries to pay $30 Million for Guidant's Sale of Defective Heart Devices for Use in Medicare Patients

WASHINGTON - Boston Scientific Corp. and its subsidiaries, Guidant LLC, Guidant Sales LLC and Cardiac Pacemakers Inc. (Guidant), have agreed to pay $30 million to settle allegations that, between 2002 and 2005, Guidant knowingly sold defective heart devices to health care facilities that in turn implanted the devices into Medicare patients, the Justice Department announced today. Boston Scientific acquired Guidant, a medical device manufacturer, in 2006.

October 17, 2013; U.S. Department of Justice Former Los Angeles-area Pastor Sentenced for Role in $11 Million Medicare Fraud Scheme

A pastor and owner of a Los Angeles-area medical supply company was sentenced today for his role in a power wheelchair fraud scheme that defrauded Medicare out of more than $11 million. Acting Assistant Attorney General Mythili Raman of the Justice Department's Criminal Division; U.S. Attorney Andr� Birotte Jr. of the Central District of California; Special Agent in Charge Glenn R. Ferry of the Los Angeles Region of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG); Assistant Director in Charge Bill L. Lewis of the FBI's Los Angeles Field Office; and Special Agent in Charge Joseph Fendrick of the California Department of Justice, Bureau of Medi-Cal Fraud and Elder Abuse made the announcement.

October 17, 2013; U.S. Attorney; Eastern District of Pennsylvania Hospice Owner Convicted in Multi-Million Dollar Health Care Fraud

PHILADELPHIA - Matthew Kolodesh, a/k/a "Matvei Kolodech", 51, of Churchville, PA, was found guilty of conspiracy to defraud Medicare of more than $14 million through his home hospice business, announced United States Attorney Zane David Memeger. A federal jury delivered its verdict today. Kolodesh's business, Home Care Hospice, Inc. ("HCH"), located at 2801Grant Avenue in Philadelphia, submitted claims totaling approximately $14.3 million for patients that were not eligible for or did not receive the hospice services billed to Medicare.

October 17, 2013; U.S. Attorney; District of Rhode Island Former R.I Doctor to Pay $1.2 Million for Fraudulent Billings to Medicare and Medicaid

PROVIDENCE, RI - Dr. Hafeez Kahn, a former Rhode Island physician with practices located in Smithfield and East Providence, R.I., will pay the government $1.2 million dollars, twice the amount of money a Settlement Agreement states he fraudulently billed the Medicare and Medicaid programs, it was announced today by the United States Attorney's Office, the Department of Health and Human Services, Office of Inspector General (HHS-OIG), and the Rhode Island Attorney General's Office.

October 17, 2013; U.S. Attorney; Northern District of Texas Father and Son Convicted on Conspiracy and Health Care Fraud Charges

DALLAS - A federal jury has convicted two local men on conspiracy and health care fraud charges related to their operation of a physician house call company in North Texas, announced U.S. Attorney Sarah R. Saldaña of the Northern District of Texas.