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

Practice Management News

OK Physician Pays $580K to Settle Medicare Fraud Allegations

Provider in Oklahoma settles Medicare fraud case with $580,000, while a Texas home health agency owner faces 480 months after a healthcare fraud scheme.

Healthcare fraud and Medicare fraud

Source: Thinkstock

By Jacqueline Belliveau

- A physician from Oklahoma recently agreed to pay $580,000 to settle a Medicare fraud case in which the federal government alleged that he submitted false claims to the federal healthcare program, the  Department of Justice (DoJ) announced.

Gordon P. Laird, MD, was the former owner and employee of Blackwell Feet Plus, LLC, and Feet Plus, LLC, later known as Prevention Plus.

During his time at Prevention Plus, Laird allegedly allowed the healthcare organization to bill Medicare using his National Provider Identification (NPI) for evaluation and management physical therapy services even though Laird did not provide or supervise the services.

The federal government also accused Laird of reactivating his NPI after leaving Prevention Plus and eliminating his identification number from the organization. He supposedly reactivated his NPI for Prevention Plus about a year later to enable the organization to bill Medicare for services he did not supervise or provide.

Laird faced a False Claims Act case, but chose to settle the case with the payment.

TX home health agency owner sentenced to 480 months in prison for healthcare fraud

READ MORE: How Providers Can Detect, Prevent Healthcare Fraud and Abuse

In another recent healthcare fraud case, a provider will face time in prison for his role in an illegal kickback scheme. A Houston-area home health agency owner received 480 months in prison for his involvement in a $17 million Medicare and Medicaid fraud case, according to a DoJ’s press release.

Godwin Oriakhi engaged in a Medicare and Medicaid fraud scheme at five of his home health agencies. He admitted in March 2017, along with his daughter and other co-conspirators, to acquiring patients by paying illegal kickback payments to recruiters and his employees.

He also confessed to paying Medicare and Medicaid patients if they allowed the home health agency to use the patients’ Medicare and/or Medicaid number to bill the healthcare programs for services. Some patients also received payments for recruiting or referring other Medicare and Medicaid beneficiaries.

In addition, Oriakhi state that he, his daughter, and co-conspirators paid illegal kickback payments to physicians, which they called “copayments,” for referring and certifying Medicare and Medicaid patients for home health services.

Medicare and Medicaid ended up reimbursing the home health agencies over $16.1 million for the false claims.

READ MORE: Strong Compliance Programs Key to Avoiding Healthcare Fraud

With the reimbursements the agencies received from the federal healthcare programs, Oriakhi continued the illegal kickback payment scheme.

As of August 2017, three others have also pleaded guilty for their involvement in the healthcare fraud scheme, including Oriakhi’s daughter and another relative. A patient recruiter also admitted to his role in the scheme.

One of the co-conspirators received 60 months in prison, while the others await sentencing.

Provider and wife from OH plead guilty in opioid-related healthcare fraud case

A former family practice provider and his wife recently confessed to engaging in a healthcare fraud scheme in Ohio that involved unlawful drug trafficking, the DoJ reported.

David Kirkwood and Beverly Kirkwood pleaded guilty to dispensing almost 4,000 units of Oxycodone “outside the scope of medical practice.” The opioid distributions were also medically unnecessary.

READ MORE: OIG Releases Healthcare Fraud Compliance Program Guidelines

After dispensing the opioids, Kirkwood admitted to billing Medicaid and Medicaid for the drugs.

Kirkwood also confessed to additional Medicaid and Medicare fraud activities. He reportedly used the same billing code for patients regardless of the services furnished and received claims reimbursement for examinations that were either medically unnecessary or insufficient for the billing codes submitted.

Beverly helped the family practice submit false medical bills.

Kirkwood agreed to pay roughly $160,000 in restitution as part of his plea. The value represented the financial losses Medicare and Medicaid experienced as a result of the healthcare fraud scheme, the DoJ stated.

The federal government also plans to seize about $2.5 million in proceeds from the scheme since Kirkwood saw approximately 100 patients per days, charging $100 per visit.

“When a doctor distributes Oxycodone without a legitimate medical purpose and outside the scope of medical practice, that’s not just bad practice. It’s unlawful drug trafficking,” stated Benjamin C. Glassman, US Attorney for the Southern District of Ohio. “In pleading guilty, David Kirkwood admitted that he was distributing opioids and other controlled substances as a drug dealer, not as a doctor.”

The husband and wife are set to face a judge for sentencing in December 2017.

Oncologist receives almost six years in jail for unapproved cancer drug use

D. Anda Norbergs will spend five years and ten months in a federal prison after a US District judge recently sentenced the Florida-based oncologist for treating patients with an unapproved cancer drug, the DoJ stated.

Norbergs reportedly ordered and asked her employees to purchase cancer drugs from foreign, unlicensed distributors, such as Quality Specialty Products. The drugs were not approved by the FDA for use on patients.

Quality Specialty Products also allegedly sold bogus versions of chemotherapy medications that did not have the primary ingredient. The federal government accused Norsberg of continuing to purchase Quality Specialty Products drugs despite knowing of the counterfeit medications.

When Quality Specialty Products closed, she also continued to buy unapproved cancer drugs from other unlicensed distributors.

Patients unknowingly received the unapproved drugs and the cancer care center billed Medicare for the services using the FDA-approved version of the drug.

Through the scheme, Norbergs aimed to make a profit from the difference between the Medicare reimbursement rate for the approved drugs and the lower prices of the illegally-required drugs.

Continue to site...