There’s No Substitute for Hard Work

25
58435332 - medical doctor writing prescription on white isolated background

There are occasions when it’s o.k. to have a substitute. For example, when a teacher is sick it is acceptable to bring in a substitute teacher to lead a class until the regular teacher can return. (But when emergency services are involved, you don’t want to substitute an Emergency Medical Technician (EMT) with someone who doesn’t know how to perform Cardiopulmonary resuscitation (CPR).) The owners of a health care company that provided ambulance services for Medicare and Medicaid beneficiaries used substitute EMTs to qualify for participation in the Medicare program, then they stole more than $6 million through fraudulent claims.

Two brothers owned and operated the health care company behind the gates of an upscale townhouse community in Houston. Their scam was carried out by first using ”stand-in” EMTs not employed by the company to take the tests necessary for certification. Once certified, the company owners proceeded to violate some of the rules set forth to protect Medicare and Medicaid beneficiaries. (It is important to note that Medicare and Medicaid only pay for ambulance services that are medically necessary, mainly for patients who cannot be safely transported any other way. Additionally, Medicare also requires two individuals to staff the ambulance vehicle and at least one of them has to be a licensed EMT.)

It appears that the brothers routinely billed the insurance programs for unnecessary trips. There were reports that individuals who were transported by ambulance were not actually bed bound, they could walk and they used the transport services for their daily activities. Apparently, one patient walked to her own therapy session, yet the ambulance company billed Medicare for more than $51,952. (It sounds like she was transported in a diamond studded limo rather than an ambulance.)

The company also paid a Houston doctor $500 per medical necessity order so they could bill Medicare. (That is definitely the wrong way to get new customers.) There were also many times when the brothers admitted they transported patients without the appropriate number of licensed EMTs on board. (I wonder if they turned on the lights and sirens to bypass a few stoplights if running late?)

The company ended up billing Medicare, Medicaid and also Tricare for a total of $6,293,108 in fraudulent claims that were not actually provided nor medically necessary. (Due to their illegal acts, they received more than $2.4 million from the three insurance providers.)

The 29- and 28-year-old brothers were convicted of conspiracy to commit health care fraud and money laundering. They are each facing up to 10 years in prison for each count or conviction plus a potential fine of $250,000. They both agreed to forfeit the Porsche and Mercedes Benz that were purchased with the illegally gained funds and to pay full restitution to the health care programs. The two men are already in federal custody awaiting sentencing.

These two fraudsters tried to take the easy way out by fraudulently billing Medicare, Medicaid and Tricare for services not performed. Because they substituted laziness for hard work, it looks like they are facing prison labor in the near future. (If fraudsters worked harder at performing legitimate jobs, perhaps there wouldn’t be a need for as many prisons.)

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”Ambulance Company Owner, Brother Convicted in $6 Million Healthcare Fraud,” published on December 10, 2016.

HOUSTON – Two brothers have been convicted on charges of conspiracy to commit healthcare fraud and money laundering, announced U.S. Attorney Kenneth Magidson.

Kevin Olufemi Davies, 29, and his brother Melvin Olusola Davies, 28, owned and operated KMD Healthcare Services Inc. (KMD) from their home in a gated townhouse community in Houston. As part of their guilty pleas, they admitted they used stand-in emergency medical technicians (EMT) who were not employees or affiliated with KMD to pass the state inspection necessary for enrollment in the Medicare program.

Read More

SHARE
Previous articleSomething Smells Fishy
Next articleA Matter of Life or Death
Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.