October 23: Week That Was in Healthcare Fraud and Malpractice
By - Here is a general roundup of the past week’s developments in healthcare fraud and malpractice, as reported by the Department of Justice and the Office of Inspector General. The crimes reported below result in multiple millions of dollars in healthcare fraud and the possibility of extensive prison time.
Millennium Health to pay $256M for medically unnecessary testing
In order to resolve allegations for billing Medicare and Medicaid for medically unnecessary drug testing and genetic testing and involvement in physician kickbacks, Millennium Health (Millennium) will pay $256 million, announced the Department of Justice earlier this week.
“The United States alleged that Millennium caused physicians to order excessive numbers of urine drug tests, in part through the promotion of ‘custom profiles,’ which, instead of being customized for individual patients, were in effect standing orders that caused physicians to order large number of tests without an individualized assessment of each patient’s needs,” states the Department of Justice.
Millennium will also pay $10 million to resolve allegations for submitting false claims from 2012 to 2015 for medically unnecessary genetic testing unqualifiable for Medicare reimbursement.
“The United States also alleged that Millennium violated the Stark Law and Anti-Kickback Statute by providing physicians with free drug test cups on the express condition that the physicians return the specimens to Millennium for hundreds of dollars’ worth of additional testing,” the Department of Justice adds.
“A laboratory which knowingly conducts medically unnecessary testing operates unlawfully and squanders our precious federal health care resources,” says Carmen M. Ortiz, United States Attorney for the District of Massachusetts. Real patients’ needs were simply not met, Ortiz adds.
Millennium’s actions threaten the overarching financial integrity of public healthcare programs, states Harold H. Shaw, Special Agent in Charge at the Boston Division of the Federal Bureau of Investigation. “The FBI hopes this settlement will send a strong message that fraudulent practices by medical labs will not be tolerated,” Shaw says.
PA ambulance driver confesses conspiracy involvement
Thael Kuran pleaded guilty this week to conspiracy to commit healthcare fraud and make false statements in association with a Brotherly Love Ambulance, Inc. (Brotherly Love) scheme. Kuran faces a possible 15 years in prison, 3 years of supervised release, a $500,000 fine, and a $200 special assessment, says the Department of Justice. Medicare was billed over $4.9 million because of Brotherly Love’s actions. Kuran’s mother, Feda Kuran, was separately charged and convicted for involvement within the scheme.
Says the Department of Justice, patients were transported via ambulance “even though those patients could walk” and were therefore ineligible for such services. The personal vehicle Thael Kuran used to transport patients – a minivan owned by Brotherly Love – lacked the needed lifesaving equipment found in an ambulance.
Patients’ medical conditions and type of provided care were misstated on certified sheets. After Brotherly Love closed operations, Thael Kuran completed similar actions at a successor company, VIP Ambulance, submitting inconsistent paperwork not legitimized by a certified Emergency Medical Technician (EMT).
As RevCycleIntelligence.com reported, the Centers for Medicare & Medicaid Services (CMS) has cracked down recently on improper Medicare billing in relation to ambulatory services. CMS tightened regulations earlier this year regarding definitions of allowable transports to ensure payment is in compliance with Medicare documentation, payment, and coding rules.
