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

Policy & Regulation News

April 3: 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. The crimes reported below result in multiple millions of dollars in healthcare fraud and the possibility of extensive prison time.

Oncologist dispenses FDA-unapproved drugs to cancer patients

Missouri-based oncologist, President, and Medical Practitioner, Robert L. Carter, waived his right to a grand jury, pleading guilty to buying and selling foreign, misbranded drugs to patients with cancer and blood diseases.

Carter prescribed, administered, and dispensed chemotherapy drugs within his practice and sought Medicare and Medicaid reimbursement for their administration. Carter was then reimbursed by government and private health insurance programs.

Such prescription cancer drugs, ordered by Carter from Quality Specialty Products (QSP) in Winnipeg, Manitoba, Canada, were obtained from foreign sources not approved by the US Food and Drug Administration (FDA) for distribution or use among healthcare providers or physicians within the US. The misbranded and FDA-unapproved drugs Carter administered to cancer patients did not bear the symbol “Rx only” and contained labeling in one more foreign languages.

Carter paid over $971,000 in restitution to Medicare, Tri-Care, Missouri Medicaid, Oklahoma Medicaid, and Kansas Medicaid. Carter will forfeit to the government $1.2 million after paying over $220,000 this week. Carter is subject to a sentence of one year in federal prison sans parole and a $100,000 fine.

PA fraud scheme leads to six year prison sentence

President and co-owner of the now defunct ambulance company Life Support Corporation (Life Support), Nazariy Kmet, will surrender to begin serving a prison term in May after pleading guilty to an extensive healthcare fraud conspiracy and paying kickbacks.

Life Support transported patients with the ability to walk and travel safely independently by means other than ambulance who were ineligible for ambulance transportation via Medicare’s requirements.

However, Kmet, and others acting on his behalf, fabricated documentation to state such patients were falsely in need of ambulance transportation. Kmet and others were fully aware patients could be safety transported by other simple means, such as walking.

Kmet paid kickbacks to patients so they would continue active utilization of Life Support’s services. Kmet then fraudulently billed for ambulance services as if they had been deemed medically necessary when such was untrue. Resultantly, Medicare paid almost $2 million for such inappropriately executed means of transportation.

NJ doctors accept bribes in $100 million clinical lab scheme

Two New Jersey doctors, Wayne Lajewski, and Glenn Leslie, were sentenced to fourteen months and twenty-four months in prison respectively for accepting bribes in exchange for test referrals as a scheme associated with Biodiagnostic Laboratory Services LLC (BLS). Lajewski and Leslie were also fined $10,000 each and will also collectively forfeit almost $400,000.

A total of thirty-seven individuals, including twenty-four physicians, pleaded guilty in association with a bribery scheme where millions of dollars in bribes resulted in over $100 million in payments from Medicare and other private insurance companies to BLS.

Lajewski admitted to accepting monthly cash bribes of over $2,000 for over two years for referring patient blood specimens to BLS. BLS received more than $380,000.

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