Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

April 17: Week That Was in Healthcare Fraud and Malpractice

By Jacqueline DiChiara

- 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.

Healthcare fraud and malpractice

$2.6 million Michigan Medicare home health scheme

Rahmat Begum of Farmington Hills, Michigan, has been charged with connections to a $2.6 million home healthcare scheme for conspiring to submit fabricated claims to Medicare via illegal kickbacks.

Begum, co-owner and operator of Empirical Home Health Care (Empirical), Inc. in Oakland County, Michigan illegally laundered proceeds via Focal Project Management Consulting.  Empirical received over $2,500 from Medicare for false and fraudulent home healthcare claims. Referrals for such claims were obtained via compensation from kickbacks.

Begum pleaded guilty this week to a series of charges including one count of conspiracy to commit wire fraud, one count of making false statements in relation to healthcare matters, one count of conspiracy in violatation of the Anti-Kickback Statute, and three counts of money laundering.

CT dental practice runs $20 million Medicaid fraud scheme

Mehran Zamani of Pound Ridge, NY, pleaded guilty this week for committing Medicaid fraud involving a multimillion dollar scheme.

Zamani, a dentist at Landmark Dental in West Haven, Connecticut defrauded the Medicaid program in excess of $20 million within two years. Zamani was hired to work at Landmark Dental by Gary Anusavice, a former dentist with a background as a convicted felon and excluded Medicaid provider. Zamani’s name and license were used within the practice as a cover or front.

In January of 2009, Zamani’s application for Landmark Dental to become a Medicaid provider omitted Anusavice’s exclusion from the Medicaid program as well as his prior criminal record. The application also did not divulge Anusavice’s direct involvement in the dental practice. Zamani submitted the fraudulent applications while being fully aware of the aforementioned information, reports confirm.

The Connecticut Medicaid program reimbursed Anusavice’s various dental practices to the tune of approximately $21 million.

“Although Gary F. Anusavice was barred from Medicare, Medicaid, and other government health programs back in 1998, he allegedly continued to defraud taxpayers by using an elaborate shield of companies and individuals — including Dr. Zamani — to hide his involvement,” states HHS-OIG Special Agent in Charge, Susan J. Waddle. “Working with federal and state partners, our investigators will penetrate such schemes and help bring suspects to justice.”

FL Hospital Orlando violates Medicare billing requirements

Although Florida Hospital Orlando (the Hospital) observed Medicare billing requirements for 121 of 215 impatient claims reviewed by the Office of Inspector General (OIG), the Hospital failed to observe Medicare billing requirements for 94 remaining claims. Such actions resulted in net overpayments of approximately $500,000.

According to OIG, the cause of such errors was due to the Hospital lacking adequate controls to prevent the erroneous billing of Medicare claims within the selected risk areas encompassing errors.

A report from the Department of Health and Human Services and OIG recommends the Hospital refund over $11,500,000 in estimated overpayments to the Medicare contractor for the audit period for claims that it inaccurately billed and additionally strengthen its controls to ensure complete Medicare requirement compliance.

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