Medicare Compliance & Reimbursement

Texas-based physician, Daniel Canchola, MD, pleaded guilty for his part in the $54 million scam. The doctor signed orders electronically for DME and cancer genetic testing prescriptions for patients he never saw, spoke to, or treated, a Department of Justice (DOJ) release indicates. In fact, the Medicare beneficiaries that Canchola prescribed for were found via health fairs and telemarketing.

“From August 2018 through April 2019, Canchola received approximately $30 in exchange for each doctor’s order he signed authorizing DME and cancer genetic test orders that were not legitimately prescribed, not needed, or not used — totaling more than $466,000 in kickbacks,” DOJ says.

Canchola also pled guilty to conspiracy to commit wire fraud and could face 20 years in prison.

Psychotherapy: Billing for psychotherapy services for deceased nursing home patients for years will get the attention of the feds.

Chicago-based psychologist Renato F. Duarte submitted false claims to Medicare from 2016 to 2019 for care he supposedly administered to nursing home patients. “Duarte’s scheme included fraudulently billing for in person services on dates that Duarte was traveling outside of the country and fraudulently billing for psychotherapy purportedly provided to patients who were deceased,” a DOJ release says.

Duarte was convicted of his crimes — four counts of healthcare fraud. He’s scheduled for sentencing next April and could face up to 10 years in prison.

Therapy: Employees have over a million more reasons to head to the authorities with their complaints about your practices, in light of a recent qui tam settlement.

Oklahoma-based Carter Healthcare, its affiliates CHC Holdings and Carter-Florida, and their president Stanley Carter and COO Bradley Carter have agreed to pay $7.175 million to resolve allegations that they violated the False Claims Act by billing the Medicare program for medically unnecessary therapy provided to patients in Florida, DOJ says in a release.

Bradley Carter will pay $175,000, Stanley Carter will pay $75,000, and Carter Healthcare will pay the remaining $6.925 million, according to the DOJ.

Stanley Carter and Bradley Carter also agreed to be excluded from participation in all federal health care programs for five years and Carter Healthcare agreed to enter a corporate integrity agreement with the OIG, the Justice Department notes.

OIG Releases Advisory Opinion Template

If you’re planning on requesting an advisory opinion on a fraud or abuse topic from the HHS Office of Inspector (OIG), the national watchdog would like you to use their new template.

In addition to the typical requestor contact information and questions, the template guides you through the process and explains what the opinion might include. Find the new offering at https://oig.hhs.gov/documents/ advisory-opinions/1054/Advisory_Opinion_Request_ Template.pdf.

Former Carter Healthcare therapists Sharon Mahaffey and Mark Brimer alleged in a whistleblower lawsuit that Carter Healthcare billed Medicare for patients based on therapy provided without regard to medical necessity and overbilled for therapy by upcoding patients’ diagnoses, the DOJ says. Mahaffey and Brimer will share $1.3 million of the settlement.