Part B Insider (Multispecialty) Coding Alert

Published on Wed Sep 14, 2011 PDF

The feds continue to rack up fraud convictions of providers across the country.

An RN formerly employed by 13 different Miami-area home health agencies recently received a 43-month prison sentence and must repay nearly $336,000 following a fraud conviction. The nurse billed for administering insulin to patients who were not insulin-dependent or homebound. In addition, the nurse was in Panama, Mexico, or the Dominican Republic during dates that she claimed to be providing visits to beneficiaries, prosecutors said. Plus, the nurse signed dozens of documents claiming she was providing skilled nursing services when she was attending classes at Florida International University. She also claimed to be providing skilled nursing visits to two and three patients simultaneously, double and triple billing Medicare, the Department of Justice (DOJ) says in a release.

In addition, the DOJ announced on Oct. 12 that the owner of a Houston-based health care company was sentenced to 33 months in prison for Medicare fraud.

The man, who owned a durable medical equipment company, pleaded guilty to conspiracy to commit health care fraud. Court documents indicated that he paid kickbacks to patient recruiters in exchange for the names of beneficiaries in whose names he could submit Medicare claims. He then billed Medicare for orthotics and braces referred to as "arthritis kits" for about $4,000 each, then gave the patients cheaper products that weren't medically necessary. His fraudulent claims totaled $846,000, the DOJ indicates.

For more on these cases, visit www.oig.hhs.gov/fraud/enforcement/criminal/index.asp.