Lower the Fraud Boom

Commentary by: Larry Benson

Today’s “Fraud of the Day” is based on an article, “Personal care assistant required to pay $25,000 for Medicaid fraud,” published by KMOV on July 1, 2016.

JEFFERSON CITY, Mo. (KMOV.com) – A personal care attendant will serve five years probation and be ordered to pay back $25,000 to Missouri’s Medicaid Program.

Yvonne Conly was originally sentenced to serve three concurrent prison sentences of five years, following her guilty pleas for Medicaid fraud back in May of this year.

Conley worked for four different personal care companies that had contracts with Medicare. She would provide healthcare services to patients in their homes, and then submit reports on all the services she provided.

January 2012 to October 2012, Conley reported that she provided healthcare services to two-or-three different patients at the same time on the same day.

Benched

Commentary by: Larry Benson

Today’s “Fraud of the Day” is based on an article entitled, “Reno owner of No Child Left Behind services guilty of fraud” posted on KOLOTV.com June 9, 2016.

RENO, Nev. (AP) – A northern Nevada company doing business as No Child Left Behind Behavioral Health Services and the 39-year-old Reno woman who owns it have been convicted of federal fraud for billing Medicaid for children’s services never provided.

Nevada Attorney General Adam Laxalt said Thursday Candia Alea Tolbert was found guilty of intentional failure to maintain adequate records, and her business guilty of submitting false claims.

Painful Mistakes

Commentary by: Larry Benson

Today’s “Fraud of the Day” is based on an article entitled, “Dover doctor pleads guilty to felony health care fraud,” published by the Delaware State News on June 27, 2016.

DOVER — A Dover pain doctor was sentenced to 18 months of probation Monday after pleading guilty to one count of felony health care fraud involving fraudulent billing practices.

Dr. Senad Cemerlic, an anesthesiologist and owner of ABG Pain Clinic, was ordered to pay $250,000 in restitution to the state Division of Medicaid and Medical Assistance and a $50,000 fine. He also must pay $10,000 to cover the cost of the investigation that began last in year in response to a tip to the state Medicaid Fraud Control Unit.

Stressed Out

Commentary by: Larry Benson

Fairfield, CT — A New Haven and Fairfield-based psychiatrist and her husband will pay $400,000 to settle a civil lawsuit that accused the couple of participating in a long-running scheme to submit false claims to a state Medicaid program.

Dr. Ashwini Sabnis, a licensed psychiatrist enrolled as a provider in the Connecticut Medical Assistance Program, and her husband, Saurav “Sam” Mohanty, co-owners of Brighter Concept, Inc., were accused of participating in an illegal scheme that resulted in the submission of false claims for services that were not provided and claims that were “upcoded,” using a higher-paying code to reflect the use of a more expensive service, procedure or device than was actually used or was medically necessary.

The Death of Fraud

Commentary by: Larry Benson

Today’s “Fraud of the Day” is based on an article entitled, “Niobara County coroner pleads guilty to Medicaid fraud,” published by Casper Star Tribune on June 28, 2016.

The Niobrara County coroner has admitted to defrauding Medicaid of more than $100,000, court documents show.

Lisa Mellott pleaded guilty June 22 to 11 counts of Medicaid fraud and two counts of forgery. Authorities say Mellott billed Medicaid for services that she did not provide to patients of her home health care business.

The Best Ever

Commentary by: Larry Benson

Today’s “Fraud of the Day” is based on an article entitled, “Williamson County Woman Must Repay State After Pleading Guilty to TennCare Fraud,” published by The Chattanoogan.com on July 6, 2016.

A Williamson County woman charged with TennCare fraud must repay the state for benefits received through the healthcare insurance program.

The Office of Inspector General (OIG) on Wednesday announced that 36-year-old Ryanne N. Cunningham of Nolensville was ordered to make restitution to TennCare in the amount of $16,775.82 after she pleaded guilty to TennCare fraud and theft of services. She also received four years judicial diversion in exchange for her plea.

Justice Served Twice

Commentary by: Larry Benson

Today’s “Fraud of the Day” is based on an article entitled, “No Witness Needed for conviction in $9.5 Million Hospice Fraud,” published by Home Health Care News on June 13, 2016.

The federal government upheld a conviction for one hospice nursing staffer who was part of a $9.5 million Medicare fraud scheme that involved overbilling for hospice services.

Seven defendants were convicted earlier this year in the case against Passages Hospice, a now-closed Illinois hospice provider, for a scheme that included falsifying patient records to bilk Medicare out of expensive care that wasn’t provided or medically necessary.

Driving Away with Fraud

Commentary by: Larry Benson

Today’s “Fraud of the Day” is based on an article entitled, “Yellow Cab parent company must pay $1.125M to resolve Medicaid fraud allegations,” published by The Dallas Morning News on June 27, 2016.

Three North Texas cab company executives and their entities have agreed to pay the U.S. more than $1 million to resolve Medicaid fraud allegations.

Jackie Bewley, Jeff Finkel and Elizabeth George — all executives at Irving Holdings, the parent company of Yellow Cab — will pay a total of $1.125 million for violating the False Claims Act, a law that penalizes parties for defrauding government programs, U.S. Attorney John Bales announced Monday. The settlement also includes Irving Holdings and six other affiliated companies.

Crushed By Wheelin’ and Dealin’

Commentary by: Larry Benson

Today’s “Fraud of the Day” is based on, “Attorney General secures $2.7 million Medicaid fraud judgment against Wheelchairs Plus president,” published by KentReporter.com on March 1, 2016.

The owner of a Seattle wheelchair company has been ordered to pay $2.7 million for fraudulently billing the Medicaid program for 119 new wheelchairs, but instead delivering used wheelchairs to the poor and disabled across the state. Michael Mann cannot avoid paying the judgment due to bankruptcy.

Mann purchased used wheelchair parts from websites such as Craigslist or from nursing home “bone yards.” Mann then cobbled together mismatched parts, including soiled pads and cushions. After reassembling chairs, he would slap on a new coat of paint and add a false serial number that identified the chair as new.

After Mann delivered the used wheelchair to a Medicaid client, he submitted a false claim to the state Medicaid program—which does not cover used wheelchairs—seeking several thousand dollars in reimbursement for a “new” chair.

There Was a Crooked Man…

Commentary by: Larry Benson

Today’s “Fraud of the Day” is based on, “Area Chiropractor Sentenced to Prison for Health Care Fraud,” a press release issued by the U.S. Attorney’s Office, District of Columbia, on March 18, 2016.

Lewis J. Levine, 59, a chiropractor who practiced in Southeast Washington, was sentenced to five months of incarceration, to be followed by two years of supervised release for his role in a scheme involving fraudulent claims to the D.C. Medicaid program.

Levine, of Laurel, Md., pled guilty in September 2014 to health care fraud and must pay $50,260 in restitution and an identical amount in a forfeiture money judgment.

Levine signed hundreds of prescriptions and plans of care in exchange for cash payments from D.C. Medicaid beneficiaries and personal care aides, who used the paperwork to justify claims to Medicaid – even though they were not prescribed by a physician as required.

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