July 31: Week That Was in Healthcare Fraud and Malpractice
By - 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.
NJ pediatrician fraudulently bills for 1,000 wound repairs
Licensed practicing Jersey City-based pediatrician, Badawy M. Badawy, MD, was sentenced this week to 21 months in prison for fraudulent Medicaid billing. According to Attorney Paul J. Fishman, Badawy billed for over 1,000 wound repair procedures never executed. This was not Badawy’s first time pleading guilty for healthcare fraud.
According to court statements and case documents, Badawy was the owner and operator of Sinai Medical Center of Jersey City LLC – a medical practice concentrating on pediatric and family medicine. Badawy submitted thousands of Medicaid claims over a 4-year period for wound repair procedures related to wounds exceeding 30 centimeters on the face, nose, lips, etc. Most of the alleged patients were children. During his plea, Badawy admitted he regularly submitted false claims for unperformed procedures where he resultantly received nearly $200,000 in Medicaid payments.
Badawy will serve 3 years of supervised release, will pay a fine of $5,000, and will pay restitution of nearly $200,000.
OK hospice owner commits Medicaid fraud, guilty on 39 counts
Paula Kluding, the owner of Oklahoma-based Prairie View Hospice, was sentenced this week to 3 years in prison for committing Medicare fraud. Kluding will pay over $2.5 million in restitution to Medicare and will spend 3 years under supervised release following her prison term.
According to trial evidence, there was fraudulent financial activity regarding reported hospice care provided for terminally ill patients. “Kluding conspired with others to conceal the true medical condition of Prairie View Hospice’s patients and the true quality and quantity of health care services they were receiving in order to 'pass' a Medicare audit and to fraudulently obtain money from Medicare,” confirms the Department of Justice. “Specifically, certain medical documents were falsified to make it appear that nurses had visited patients or conducted necessary assessments when such visits and assessments had not, in fact, been made,” the news release adds.
Following a nearly five-day trial with a 6-hour jury deliberation, a guilty verdict was delivered on 39 separate counts relating to Medicare fraud, conspiracy, federal audit obstruction, and delivering false statements.
Detroit owners convicted in $33M Medicaid fraud scheme
Zafar Mehmood and Badar Ahmadani are in hot legal waters this week for their involvement in a large Medicare fraud scheme. Both were convicted this week, as the Department of Justice confirms.
“Zafar Mehmood, 49, of Ypsilanti, Michigan, was convicted of conspiracy to commit health care fraud, four counts of health care fraud, one count of conspiracy to pay and receive health care kickbacks, one count of conspiracy to commit money laundering and two counts of money laundering,” reports the Department of Justice. “Mehmood also was convicted of two counts of obstruction of justice related to his theft of evidence from an HHS-OIG facility. Badar Ahmadani, 48, also of Ypsilanti, was convicted of one count of conspiracy to commit health care fraud and one count of conspiracy to pay and receive health care kickbacks.”
Evidence at trial suggested physicians were paid kickbacks to refer patients for unnecessary home healthcare services, records were falsified, and cash kickbacks were paid to recruiters.
