Damico & Stockstill, Attorneys at Law

Medicare fraud can be costly for all

The owner of a south Louisiana home health care company and his chief nurse, who together masterminded a health care fraud scheme were both convicted recently, and on top of that their company was ordered by the court to pay back to Uncle Sam $17.1 million.

As the feds battle this ever-growing brand of white collar crime, the 64-year-old owner was sentenced to serve 150 months in the slammer and forfeit $9.2 million -- in addition to the $17.1 million in restitution. His 60-year-old wife and director of nursing pulled 60 months in prison.

According to the evidence adduced at trial, the modus operandi was fairly straightforward but involved the criminal participation of many. In short, the convicted pair paid kickbacks to patient recruiters to obtain Medicare beneficiary information. Dishonest nurses would then fake qualification documents designating these beneficiaries qualified for home health services.

What's worse, the convicted owner hired and paid kickbacks to medical doctors to sign fraudulent referrals and certifications for home health services. The convicted pair then used the Medicare beneficiary information and false documents to bill Medicare for the unnecessary home health services. The scheme lasted from 2005 through 2011, with Medicare forking over $17.1 million based on these fraudulent home health care claims.

What finally caught up with the crafty duo was a combined team of FBI, HHS-OIG and the Medicaid Fraud Control Unit of the Louisiana State Attorney General's Office -- all operating as part of the Medicare Fraud Strike Force, under supervision of the Criminal Division's Fraud Section and the U.S. Attorney's Office for the Middle District of Louisiana.

This formidable lash up, conceived in 2007, has spread its investigative tentacles into nine cities across the country, compiling an impressive record of accomplishment that should discourage other plotters. It has charged more than 1,500 defendants who have together hit-up the Medicare program for more than $5 billion.

Anyone caught up in the ever-widening dragnet certainly needs the services of an experienced attorney to keep the damages to a minimum.

justice.gov, "Operators of Louisiana Home Health Company Sentenced for $17.1 Million Health Care Fraud Scheme" No author given, Aug. 15, 2013

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