Florida Therapy Staffing Company Owner and Patient Recruiter Plead Guilty to $7 Million Medicare Fraud Scheme

Thursday, August 29, 2013
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A therapy staffing company owner and a patient recruiter pleaded guilty on August 21, 2013, to one count each of conspiracy to commit health care fraud in connection with a $7 million Medicare fraud scheme. The scheme allegedly involved a now defunct home health care agency, Anna Nursing Services Corp., in Miami Springs, Florida, according to the Department of Justice (DOJ). The agency was supposed to provide home health and therapy services to Medicare beneficiaries.

Click here to read the press release from the DOJ.

The staffing company owner and patient recruiter each face up to 10 years in prison.


Medicare Fraud Scheme Involved Fake Patient Files and Paying Off Co-Conspirators.


According to the DOJ, the patient recruiter worked for Anna Nursing Services. The patient recruiter allegedly paid kickbacks to other patient recruiters in return for providing patients to Anna Nursing Services. He is also accused of paying off co-conspirators at doctors’ offices for prescriptions and medical certifications that were used to fraudulently bill Medicare.

The staffing company owner provided therapists to Anna Nursing services. According to the government, the staffing company owner created fictitious progress notes and other patient files indicating that therapists from his company provided physical or occupational therapy services to Medicare beneficiaries. In many cases those services were never provided or medically unnecessary. The fictitious documents were used to support false claims for services billed to Medicare.

The DOJ claims that from October 2010 to April 2013, Medicare paid the home health care agency approximately $7 million in false claims for services that were medically unnecessary or never rendered. The staffing company owner and the patient recruiter will be sentenced on November 15, 2013, according to the DOJ.


Case Investigated by Heath Care Fraud Prevention and Enforcement Team.

This case was investigated by the Health Care Fraud Prevention and Enforcement Action Team (HEAT). HEAT is a multi-agency team of federal, state and local investigators who combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing.

The Affordable Care Act has given HEAT additional tools to preserve Medicare by expanding the team’s authority to suspend Medicare payments and reimbursements when fraud is suspected. To learn more about HEAT and how it is increasing its anti-fraud efforts, click here to read a previous blog.


What You Need to Know about Medicare and Medicaid Audits.

I previously wrote a two-part blog on the increased number of Medicare and Medicaid audits being initiated against health professionals who treat home health care, assisted living facility (ALF) and skilled nursing facility (SNF) residents. This area of medical practice has been identified as one fraught with fraud and abuse. To learn more on the areas being targeted and how to respond to different types of audits, click here for the first blog, and click here for the second.


Don't Wait Until It's Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.
 
The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.


Comments?

Do you think similar schemes are fairly common? Do you think we will see more news stories like this with the increased anti-fraud efforts of HEAT? Please leave any thoughtful comments below.


Sources:

Department of Justice. “Therapy Staffing Company Owner and Patient Recruiter Plead Guilty in $7 Million Health Care Fraud Scheme.” Department of Justice. (August 21, 2013). From: http://www.justice.gov/opa/pr/2013/August/13-crm-946.html?utm_medium=email&utm_source=govdelivery

Staffing Industry Analysts. “Staffing Firm Owner Pleads Guilty in $7 Million Scheme.” Staffing Industry Analysts. (August 22, 2013). From: http://www.staffingindustry.com/Research-Publications/Daily-News/US-Staffing-firm-owner-pleads-guilty-in-7-million-scheme-26962


About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.


Tag Words: Medicare, Medicare fraud, Medicare fraud scheme, Medicare audit, false claims, Department of Justice (DOJ), health care fraud, health care fraud scheme, patient recruiter, home health care company, Health Care Fraud Prevention and Enforcement Action Team (HEAT), kickbacks, Medicare beneficiaries, services not rendered, health care kickbacks, defense attorney, defense lawyer, Florida health care attorney, Florida health care lawyer, The Health Law Firm, health law


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8/29/2013

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