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

Policy & Regulation News

July 2: 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.

fraud in healthcare

Illegal kickbacks in CA Medicare, Medi-Cal scheme

Sylvia Water-Eze, former owner of Ezcor Medical Supply, a durable medical equipment supply company, was sentenced this week to 97 months in prison for participating in a $3.5 million fraud scheme. Walter-Eze was found guilty of conspiracy to commit healthcare fraud, 4 counts of healthcare fraud, and 1 count of conspiracy to pay illegal healthcare kickbacks.

Walter-Eze billed for durable medical equipment that was not medically necessary, paid illegal kickbacks to patient recruiters to receive patient referrals, and paid physicians kickbacks for sham, medically unnecessary prescriptions.

Over an approximate 5-year period, Walter-Eze submitted over $3.5 million in fraudulent claims to Medicare and Medi-Cal and received nearly $2 million in reimbursement for doing so. She will pay over $1.8 million to Medicare and over $73,000 to Medi-Cal.

$1.5M recovered in home healthcare civil settlement

Byron and Laura Harris, owners and operators of Indianapolis-based United Home Healthcare, Inc and B&L Personal Services, Inc, are involved in a $1.5M civil settlement this week.

Agents and investigators with the Department of Health and Human Services (HHS) and the Indiana Attorney General’s Office interviewed both patients and former employees and reviewed patient files after a complaint was investigated upon which insinuated both companies were billing for services that were not actually provided.

“It’s a brazen violation of public trust when a healthcare provider hired to assist patients then fraudulently bills the Medicaid program, as taxpayers ultimately are victims in such a scheme,” explains Indiana Attorney General Greg Zoeller. “With the legal tool of the False Claims Act that encourages whistleblowers to come forward, the State of Indiana and our federal counterparts are able to claw back the tax dollars that were wrongfully paid out and hold defendants accountable,” Zoeller adds.

According to Assistant Attorney Shelese Woods, after reviewing patient files, it was determined a pattern of overbilling for services was evident and there were many discrepancies. Dates patient files claimed patients had received services did not match reimbursement documentation; the numbers of service hours had also been over-billed.

"The civil False Claims Act was created to serve as a tool for combating fraud, waste and abuse in federally funded programs," states Josh J. Minkler, Attorney for the Southern District of Indiana. "A financial injury to the United States is a financial injury to all of us. This recovery sends the message that health care providers must comply with various applicable state and federal regulations when billing the United States Government for services, or they will face consequences," he adds.

Both companies, collectively referred to as “United,” will pay over $1.4 million to the US, over double the estimated loss incurred. United additionally agrees to pay over $45,000 to the State of Indiana for costs and fees associated with the investigation.

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