Policy & Regulation News

March 6: 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.

Woman with fake credentials treats children, infants

Shawna Michelle Gunter, 37, who pretended to be a physician’s assistant in Maryland, was sentenced to three years in prison and an additional three years of supervised release with six months of home detention with electronic monitoring. Gunter will pay restitution of over $53,000.

Gunter submitted fake credentials she had forged from another real doctor when applying to become a physician’s assistant. A fabricated resume she had faxed along to a doctor when asked to provide academic verification said she had graduated from Howard University with a degree as a physician’s assistant which was untrue.

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  • Gunter had previously lost her job as a surgical assistant for stealing a check from a doctor and forging his signature to pay for remodels on her boyfriend’s home.

    Although she lacked formal medical training or medical licenses, Gunter treated 137 infants and children without direct supervision and wrote over 400 prescriptions for controlled substances.

    As a result of Gunter’s unlicensed and unqualified care, which included treating children diagnosed with ADHD, the pediatrician’s practice received $19,000 for unknowingly filed hundreds of false Medicaid claims.

    Catholic nursing chain pays $3.5 million in inflated claims

    The operator of The Catholic Health Care System (Archcare), a New York skilled nurse facility, entered into an agreement to pay $3.5 million regarding allegations for rehabilitation therapy claims and allegations for failing to prevent a rehab subcontractor, Physical and Occupational Rehabilitation Therapy and Speech-Pathology Services (PLLC), from overbilling Medicare for therapy services.

    Claims from each of Archcare’s three New York facilities—Terence Cardinal Cooke Health Care Center in NYC, Ferncliff Nursing Home in Rhinebeck, and Kateri Residence in NYC, requested inflated reimbursement amounts involving false reports of therapy that were never actually delivered.

    The Archcare facilities frequently billed patients for much higher levels of rehabilitation therapy than was deemed necessary or reasonable. They also arbitrarily changed multiple types of documentation in an effort to inflate Medicare reimbursement.

    Additionally, Archcare billed Medicare patients for the highest therapy-based levels although such levels were not actually administered.

    Secret $1 million California kickback scheme revealed

    Dr. Charles “Chuck” R. Denham, MD, of Laguna Beach, CA, agreed to pay $1 million for illegally soliciting and accepting kickbacks.

    As co-chair of the Safe Practices Committee, Denham received monthly undisclosed payments from CareFusion Corporation in violation of the Federal Anti-Kickback Statute.

    Denham solicited payments in exchange for false or fraudulent claim activity regarding the recommendation and promotion of CareFusion’s ChloraPrep product.