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

Policy & Regulation News

November 13: Week That Was in Healthcare Fraud and Malpractice

Four Texan defendants allegedly paid Medicare beneficiaries with illegal kickbacks; three Florida therapists and former medical director sentenced to jail in a $63M scheme.

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

Houston’s $13M Medicare illegal kickback conspiracy

Houston, we have an illegal kickback problem. Ebong Tilong and Marie Neba of Sugar Land, Texas – were both arrested early Tuesday morning for their alleged involvement in a multi-million dollar Medicare fraud conspiracy theme.

The home-health agency they owned and directed was used to bill Medicare for nonexistent or medically unneeded services, according to an indictment. Says the Department of Justice, such is merely a formal accusation at this time with defendants currently presumed innocent.

Neba, a director of nursing, may have falsified medical records to make it seem like Medicare beneficiaries indeed qualified for and received home-health services although such documentation had allegedly been altered and fabricated, confirms the Department of Justice.

For a nearly nine year period beginning in 2006, both Tilong and Neba received nearly $13 million for such allegedly fabricated or unnecessary home-health services.

Illegal kickbacks were supposedly paid to physicians and others – including Daisy Carter and Connie Ray Island – in exchange for the referral of Medicare beneficiaries to home-health services.

These four defendants supposedly paid Medicare beneficiaries with illegal kickbacks in exchange for billing actions through Medicare. False and incorrect Medicare information for home-health services was allegedly used to help achieve this fraudulent goal.

Sentencing in $63M Miami healthcare fraud scheme

Three therapists and a former medical director have been sentenced in Miami, Florida for their involvement in an over $63 million fraud scheme.

Roger Rousseau, the former medical director of the now defunct Health Care Solutions Network Inc. (HCSN), was sentenced to 192 months in jail, confirms the Department of Justice.

As RevCycleIntelligence.com reported, Rousseau rarely met with patients, failed to review records, and knowingly signed altered and incorrect medical records involving a kickback scheme.

Therapist Liliana Marks was sentenced to 72 months in prison; therapists Doris Crabtree and Angela Salafia were each sentenced to 60 months.

Marks, Crabtree, and Salafia falsified HCSN medical records to back false and fraudulent claim information for partial hospitalization program services that were generally nonexistent.

Each defendant also must serve three years of supervised release in addition to jail time, says the Department of Justice, with restitution to be determined this January.

HCSN, which claimed to provide intensive care for the mentally ill, billed both Medicare and Medicaid over the course of about 7 years for medically unnecessary health services.

Additionally, HCSN paid kickbacks to assisted living facility owners and operators.

Over $63 million in false and fraudulent claims was submitted by HCSN to Medicare and Medicaid. Medicare and Medicaid paid for $28 million of this amount.

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