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

Policy & Regulation News

Feb. 20: Week That Was in Healthcare Fraud, 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.

Physician employed an underqualified professional to examine, diagnose patients on his behalf

This week during a five-day trial, Devon Golding, MD, of St. Louis, Missouri was convicted of rendering Medicaid services and billing charges to patients when he was actually physically out of town.

Although Golding was typically present in his office two to three times per week, he employed a registered nurse from September 2009 to November 2011 to act on his behalf five days a week. Although Golding knew the registered nurse had failed her nurse practitioner exam several times throughout her employment, she still examined and diagnosed patients, prescribed narcotic medications, and ordered lab test results. Nonetheless, she actively performed services well beyond her qualifications as her registered nurse, including finalizing patients’ progress notes, which Golding signed upon his return to the office.

Golding was convicted of three felony counts of healthcare fraud and two felony counts of making false statements related to health services, the United States Attorney’s Office for the Eastern District of Missouri reports.

Each healthcare fraud count carries a maximum penalty of ten years prison time and/or fines up to $250,000. In addition, each count of falsifying statements carries a maximum of five years in prison and/or fines of up to $250,000.

Florida home health company owner connected to $13.7 million Medicare scheme

The owner and operator of Longcare Home Health Corporation, Alexander Lara, 46, pleaded guilty this week to one count of conspiracy to commit healthcare fraud. The case involves an extensive investigation of personally paid kickbacks and bribes to Medicare beneficiaries and patient recruiters in exchange for fraudulent prescriptions and patient referrals.

Lara admitted to personally overseeing fraudulent claim submission. Lara also admitted he and co-conspirators operated their home health agency under the guise of providing home health and therapy services to Medicare beneficiaries. As leader of a series of schemes, Lara billed Medicare for medically unnecessary and costly physical therapy and home health care services.

From January 2009 through November 2014, Medicare paid $13.7 million for Longcare Home Health’s submitted fraudulent claims.

Virginia doctor pleads guilty to oxycodone distribution linked to patient’s death

Nibedita Mohanty, MD, 56, of Stafford, Virginia, pleaded guilty this week to the distribution and release of controlled substances. Mohanty, former Chief of Medicine at Virginia’s Stafford Hospital, faces a maximum penalty of 20 years in prison for admitting to issuing oxycodone prescriptions without legitimate medical purpose.

On May 2, 2001, one such prescription resulted in a patient’s oxycodone-related nonfatal narcotics overdose. Mohanty later treated this patient at the hospital. Years later, Mohanty issued the same patient another oxycodone prescription resulting in accidental acute combined oxycodone and imipramine toxicity.



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