May 1: 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.
Twenty-six physicians plead guilty in test-referral scheme
Anthony DeLuca, MD, of Point Pleasant, NJ, was sentenced this week to one year and one day in prison for accepting bribes in exchange for test referrals involving a lengthy scheme with Biodiagnostic Laboratory Services LLC (BLS). DeLuca will additionally serve one year of supervised release and has been ordered to pay a fine of $5,000.
According to reports, DeLuca admitted to accepting monthly bribes of $1,500 from another individual in his medical office also associated with the scheme. Bribes were accepted by DeLuca in exchange for the submission and referral of patient blood specimens to BLS. As a result of the bribery scheme, the medical lab collected over $100,000 for submitted claims.
Including DeLuca, a total of 38 other individuals – including 26 physicians – pleaded guilty to involvement in the bribery scheme. Those who organized the scheme admitted there were millions of dollars in bribes resulting in $100 million in Medicare payments to BLS. Over $10 million has been recovered via investigation thus far through forfeiture.
This is not the first time BLS has been involved in bribery matters. In 2013, David Nicoll, BLS President, pleaded guilty to bribing physicians, illegally netting the company $100 million.
Nicoll led an elaborately lavish lifestyle with his illegally obtained funds, purchasing Ferraris, Corvettes, private jets, and hundreds of thousands of dollars in tickets to sporting events, according to Attorney Paul Fishman’s statement during a 2013 press conference.
States FBI Special Agent in Charge Aaron T. Ford in relation to Nicoll’s bribery scheme, “Health care fraud is a serious crime which impacts all Americans either directly or indirectly, by inflating costs in the health care system."
Boston clinical care technician steals pain medication
Michelle R. Tomlinson, a former clinical care technician at Tufts New England Medical Center, has been charged this week with secretly stealing pain medication from intensive care patients.
Tomlinson allegedly entered three patients’ rooms within the surgical intensive care unit under false pretenses and surreptitiously diluted and extracted Dilaudid/hyrdromorphone through a syringe from their IV bags, according to a charging document.
Tomlinson faces a possible maximum prison sentence of four years, a maximum of three years of supervised release, and a possible fine of $250,000.
Alabama CFO defrauds millions from the government
Terri McGuire Mollica, a former Chief Financial Officer of a pair of non-profit health clinics in Alabama for the economically disadvantaged and homeless, pleaded guilty this week to various federal charges connected to a hefty fraud scheme. Mollica defrauded millions of dollars from clinics and the federal government health agencies.
Mollica pleaded guilty to 19 counts of fraud against the government, 6 counts of wire fraud affecting a financial institution, 8 counts of mail fraud, and 5 counts of money laundering. Last year, Mollica was indicted by a federal grand jury on 74 counts to defraud the government, 5 counts of filing false tax returns, and 3 counts to defraud a life insurance company.
Mollica will voluntarily forfeit over $930,000 which the government seized last year from investment and credit union accounts. Mollica conceded such funds were obtained illegally.
GA hospital pays $20 million, overcharges Medicare patients
As reported earlier this week on RevCycleIntelligence.com, The Medical Center of Central Georgia (MCCG), known as Medical Center/Navicent Health, will pay $20 million in violation of the False Claims Act. MCCG allegedly charged the government for costly inpatient services that should have been billed as more cost-effective outpatient or observation services.
