Feds ban some Medicare providers in crackdown

Editor's note: Maybe now...orange jumpsuits for the Cook County Probate Court judges?  Lucius Verenus, Schoolmaster, ProbateSharks.com


Jul 26, 6:56 PM EDT Feds ban some Medicare providers in crackdown

     By KELLI KENNEDY
          Associated Press googletag.cmd.push(function() { googletag.display('rectangle'); }); MIAMI

    (AP) -- For the first time in history, federal health officials said Friday they will ban certain types of Medicare and Medicaid providers in three high-fraud cities from enrolling in the taxpayer-funded programs for the poor as part of an effort to prevent scams. The strict moratoriums, which start Tuesday, give federal health officials unprecedented power to choose any region and industry with high fraud activity and ban new Medicare and Medicaid providers from joining the programs for six months. They wouldn't ban existing providers. The administrator of the Centers for Medicare and Medicaid Services said the agency is targeting providers of home health care in eight counties in the Miami and Chicago areas. All ambulance providers would be banned in eight counties in the Houston area. "We fully support the action taken," said Val J. Halamandaris, president, National Association for Home Care & Hospice. "NAHC has long supported program integrity measures such as this and strongly recommended that Congress give CMS the authority to issue a moratorium as part of the Affordable Care Act. We look forward to continue working with CMS as it considers other areas of the country where a moratorium may be needed," Halamandaris said. The moratorium, which was first reported by The Associated Press, will also extend to Children's Health Insurance Program providers in the same areas, agency administrator Marilyn Tavenner said in a statement. It's unclear how many providers will be shut out of the programs. There were 662 home health agencies in Miami-Dade in 2012 and the ratio of home health agencies to Medicare beneficiaries was 1,960 percent greater in Miami Dade County than other counties, according to figures from federal health officials. South Florida, long known as ground-zero for Medicare fraud, has also had several high profile prosecutions involving that industry. In February, the owners and operators of two Miami home health agencies were sentenced for their participation in a $48 million Medicare fraud scheme. The number of home health providers in Cook County, Ill., increased from 301 to 509 between 2008 and 2012. There were 275 ambulance suppliers in Harris County, Texas, in 2012. The ratio of providers to patients in both regions was also several hundred times greater than in other counties, federal health officials said. Top Senate Republicans have criticized the agency for not using the powerful moratoriums sooner as a tool to combat an estimated $60 billion a year in Medicare fraud. Senators Chuck Grassley, who is the ranking Republican on the Judiciary Committee, and Orrin Hatch, who is the ranking Republican on the Finance Committee, sent a letter to federal health officials in 2011 urging them to use the bans. "While it's certainly better late than never, it's unfortunate that it took CMS three years to use the tools it's had to protect seniors," Hatch said in a statement Friday, adding he hoped "to see more action like this." Officials for the Department of Health and Services inspector general lobbied hard to ensure moratorium power was included under the Affordable Care Act as the Obama administration focuses on cleaning up fraud on the front end by preventing crooks from getting into the program in the first place. "There's no shortage of bad actors to defraud the taxpayers, and the number gets bigger all the time, so it's good to see the administration at last using this new tool to fight fraud," Grassley said in a statement. In the past, federal health officials tried to stall new provider applications from being processed, hoping to slow the number flocking to high-fraud sectors. But when providers inevitably complained, the agency had to process their paperwork. The federal agency can also revoke the IDs of suspicious providers, but those are temporary and many companies are able to reenroll later or enroll under a different name. Federal health officials have been reluctant to use one of its most powerful new tools, worrying moratoriums may harm legitimate providers and hamper patients' access to care. Tavenner said in the statement that would not happen, but the agency didn't elaborate. Agency officials said they intend to consider other moratoriums in different industries in other cities going forward. The ability to target certain industries and cities is especially helpful as Medicare fraud has morphed into complex schemes over the years, moving from medical equipment and HIV infusion fraud to ambulance scams, as crooks try to stay one step ahead of authorities. Fraudsters have also spread out across the country, bringing their scams to new cities once authorities catch onto them. The scams have also grown more sophisticated, using recruiters who are paid kickbacks for finding patients, while doctors, nurses and company owners coordinate to appear to deliver medical services that they are not. The moratoriums come as budget cuts are forcing federal health officials to retract its watchdog arm as it launches its largest health care expansion since the Medicare program. Health and Human Services inspector general officials said they are in the process of cutting 20 percent of its staff, from 1,800 at its peak to 1,400, and cancelling several high profile projects, including an audit that would have investigated technology security in the federal and state health exchanges launching in October. The project was slated to examine issue including whether patient information was secure from hackers on the online marketplace, where individuals and small businesses can shop for health insurance. -- Follow Kelli Kennedy on Twitter: http://twitter.com/kkennedyAP - See more at: http://hosted.ap.org/dynamic/stories/U/US_MEDICARE_FRAUD_MORATORIUMS_FLOL-?SITE=FLTAM&SECTION=STATE&TEMPLATE=#sthash.2bIbedQj.dpuf

Two Chicago-area physicians charged in Medicare probe

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By: Andrew L. Wang 
May 14, 2013

Seven people, including two physicians, were charged in federal court in Chicago today with Medicare fraud as part of a federal sweep that targeted eight cities.

The broader investigation netted charges against 89 doctors, nurses and other medical professionals who allegedly submitted a total of $233 million in fraudulent claims to Medicare, the federal health insurance program for the elderly and disabled.

The investigation was conducted by the Medicare Fraud Strike Force, a joint effort of the U.S. Justice Department and the U.S. Department of Health and Human Services, which administers Medicare.

The following Chicago-area residents were charged:

• Ankur Roy, 36, of Miami, Fla., Akash Patel, 33, of Morton Grove, and Dipen Desai, 33, of Chicago, who are described as owners of Selectcare Health Inc., an outpatient respiratory and physical therapy provider with locations in Skokie and Park Ridge.

Messrs. Roy, Patel and Desai are accused of submitting claims to Medicare and Blue Cross & Blue Shield of Illinois for services that could not have been provided, either because a respiratory therapist was not working at the times described or because the services described were in excess of any care scheduled for their patients, federal authorities allege.

Between April 2010 and April 2011, the defendants were paid $2.2 million from Medicare and $321,000 from Blue Cross, according to an indictment. Each man has been charged with six counts of health care fraud.

“Mr. Desai plans a vigorous defense to the case. He recognizes the seriousness of the allegations, and he plans to enter a plea of not guilty at the arraignment,” said his lawyer, Lawrence Hyman of Chicago. The other defendants did not respond to calls for comment.

• Dr. Cecilia Ibrahim, 50, an internist from Frankfort with an office in Flossmoor, has been charged with a single count of health care fraud. She is accused of using a code for a spinal surgery to bill for nonsurgical procedure performed 3,200 times from March 2006 to August 2009, federal authorities allege. She was allegedly improperly paid $300,000 by Medicare and $550,000 by Blue Cross.

The insurer sued Dr. Ibrahim last year. She did not immediately return a call for comment.

• Ellyse Lamon, 30, an Elmhurst resident and account executive for a medical equipment seller, allegedly altered claims in 2010-11 to reflect that a physician had prescribed back braces and nerve stimulation units to patients, even though no prescription had been written.

The claims resulted in $206,000 in improper payments to the company by Medicare, for which Ms. Lamon received increased commissions, federal authorities say. She is charged with one count of health care fraud. Ms. Lamon did not return a message requesting comment.

• Dr. Nalini Ahluwalia, 58, an internist from Burr Ridge, is charged with accepting a $1,000 kickback for referring two patients to a home health care agency in August 2012. The payment was recorded, the government alleges.

An informant told federal investigators that Dr. Ahluwalia previously had accepted kickbacks of $400 or $500 per patient for referrals of Medicare patients. She is charged with one count of violating the anti-kickback law.

Dr. Ahluwalia did not return a message for comment.

• Joseph Dickson, 65, a Lansing-based operator of a medical marketing agency, was charged with accepting $4,200 in kickbacks for referring seven Medicare patients to a home health provider in a recorded October 2012 meeting.

An informant told authorities that Mr. Dickson was a middleman who arranged referrals from a doctor, and that he accepted about $15,000 in kickbacks from 2006 to 2008, federal authorities say. Mr. Dickson, who was charged with one count of violating anti-kickback statutes, could not be reached for comment.

Each charge of health care fraud against Messrs. Roy, Patel and Desai, Dr. Ibrahim and Ms. Lamon carries with it a maximum possible prison sentence of 10 years and a fine of up to $250,000 or twice the loss incurred by the fraud, the government says.

The kickback charges against Dr. Ahluwalia and Mr. Dixon carry a maximum prison sentence of five years and a $250,000 fine, according to the government.