Policy & Regulation News

August 7: 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.

Medicare fraud in healthcare

Boston multi-million dollar conspiracy fraud scheme

Janice Troisi, a clinical director and registered nurse at the home nursing agency At Home VNA was convicted this week of 10 counts of healthcare fraud, 7 counts of money laundering, and conspiracy to commit healthcare fraud for her involvement in a multi-million dollar Medicare scheme. She was sentenced last February to 92 months in prison.

Her co-conspirator, registered nurse Michael Galatis, submitted over $27 million in mostly medically unnecessary, fraudulent claims to Medicare and Medicaid over a six-year period. Numerous complaints from physicians and nurses stating patients did not need the home health services they were receiving were ignored to ensure billing remained steady. According to the Department of Justice, Troisi and Galatis trained nurses to manipulate Medicare assessment forms. Nearly 1,400 patients were misleadingly documented as having been treated.

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  • “In 2011, Medicare passed a new regulation requiring that the physician certify that she or he had a face-to-face encounter with the patient about the need for home health care,” confirms the Department of Justice. “Even after this regulation was enacted, Troisi continued to prepare certifications and orders for home health care for a doctor to sign despite knowing that the doctor had not examined any of the patients.  This allowed Galatis to bill Medicare for millions of dollars of home health care despite the new regulation.”

    Texas CEO pleaded guilty in Medicaid fraud scheme

    Alexis C. Norman, CEO and Executive Director of Greater Southwest Group, Inc. and Ellis County Community Services, pleaded guilty this week to 1 count of healthcare fraud and faces a possible decade behind bars.

    Norman submitted fraudulent claims to Medicaid by attaining group numbers and provider numbers from licensed counselors and recipient material. Although Norman was not a psychotherapist or mental health provider, she submitted claims for having performed psychotherapy sessions by using the secretly obtained Medicaid provider information to do so. Those who were connected to the provider information were not aware such was being done, nor did they work for Norman, Greater Southwest Group, Inc., or Ellis County Community Services. Norman remains on bond and faces sentencing in mid-November.

    “The indictment alleges that Norman used the identification of more than 500 Medicaid recipients, most of whom were minor children, in her scheme,” states the Department of Justice. “From December 2, 2009, through July 17, 2014, Norman submitted claims to Medicaid and to Medicaid Managed Care Organizations, through GSWG and ECCS, totaling approximately $5,502,724.88; Norman was paid approximately $2,596,045.97 for these claims.”