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At a time when our attention is drawn to massive Medicare fraud investigations involving hundreds of defendants, it is important to remember that the government brings out its full firepower to investigate and prosecute individuals as well. This week a United States District Judge in Florida sentenced an individual Occupational Therapy Assistant to 30 months in federal prison for defrauding Medicare and Medicaid. The court also ordered the defendant to forfeit $455,537.30 in overpayments. According to a press release from the local U.S. Attorney's office, the defendant owned Active Life Rehab, Inc. He was charged with health care fraud and aggravated identity theft for submitting fraudulent claims of more than $1 million to the Medicaid program. The claims submitted were for occupational therapy services that were either not provided at all, or not provided as billed to Medicaid. The fraud allegedly was carried out by falsifying patient records, "upcoding," and using unauthorized Medical Provider Numbers of other licensed occupational therapists to submit claims to Medicaid for payment to Active Life Rehab. False claims were also submitted to Medicare. In total, Medicaid and Medicare were billed approximately $1.5 million of which $455,537.30 was unwarranted. This case was investigated by the Tampa Bay Medicare Fraud Strike Force, which comprises agents from the Tampa Regional Office of the Department of Health and Human Services, Office of the Inspector General (HHS-OIG), the Federal Bureau of Investigation (FBI), the Florida Attorney General’s Medicaid Fraud Control Unit (MFCU), Florida Department of Law Enforcement (FDLE), and the Defense Criminal Investigative Service Office of Investigations. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules.
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Nephrology Physician Practice Group and Dialysis Centers Accused of Overbilling Medicare Apex Medical Group, P.C., d.b.a. Nephrology Consultants, a Tennsessee-based nephrology physician practice group, has agreed to pay $4.36 million to settle alleged violations of the federal False Claims Act, the Tennessee Medicaid False Claims Act, and other federal and state laws and regulations. The U.S. Attorney for the Eastern District of Tennessee asserted that the group submitted numerous false and fraudulent claims to government health programs, including Medicare and TennCare, for payment through a pattern of upcoding for various physician services. “Upcoding” refers to using billing codes that reflect a more severe illness than actually existed or a more expensive treatment than was provided. The government also contended that six dialysis clinics owned by Extracorporeal Technologies, Inc., and Fort Sanders Kidney Center, Inc., improperly submitted inaccurate claims to the same government health programs for a variety of dialysis services. As part of the overall settlement, Apex and Dr. Naseemul Siddiqi entered into a comprehensive five-year Integrity Agreement with the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS). The OIG negotiates integrity agreements with health care providers to ensure future compliance with federal health care benefit program requirements. In exchange, the OIG agrees not to seek their exclusion from participation in Medicare, Medicaid, or other Federal health care programs. Click here to see the government's press release on the settlement. John Howley, Esq. New York, New York The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. |
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DisclaimerThis web site provides general information. It does not provide legal advice. You should consult a lawyer to obtain legal advice regarding your personal situation. |