Part B Insider (Multispecialty) Coding Alert

Published on Wed Nov 07, 2012 PDF

The government is proving that it's no longer keeping its hands off of physicians when busting a home care fraud scheme. A federal jury in Detroit convicted physician Pramod Raval, physical therapist and HHA owner Chiradeep Gupta, and patient recruiter Richard Shannon on fraud and other counts, according to a release from the Department of Justice.

In the $14.5 million scheme conducted at Patient Choice Home Healthcare Inc. and All American Home Care Inc., patient recruiters paid Medicare beneficiaries to sign blank documents for physical therapy services that were never provided and/or medically unnecessary, prosecutors said in the trial. The owners of Patient Choice and All American paid physicians, including Raval, to sign referrals and other therapy documents. Then PTs and PT assistants provided through contractors would create fake medical records using the blank, pre-signed forms obtained by the patient recruiters to make it appear as if PT services were actually rendered when they were not provided, according to prosecutors.

Sixteen other defendants already have pled guilty in the scheme, the DOJ says.

To read more about the conviction, visit www.justice.gov/opa/pr/2012/October/12-crm-1297.html.