Justice Served Twice

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11758918 - accounting.

Witnesses are not always needed in order to convict someone of a crime. A story published by Home Health Care News tells about a case against a woman convicted for taking part in a hospice-related health care fraud. She asked for a new trial claiming that there was not enough evidence against her since no witness identified her in court the first time around. (Is that like trying to get out of a traffic ticket when the arresting officer does not come to court?)

The woman at the center of this case was the director of nursing assistants for an Illinois hospice provider and the seventh person convicted in a health care fraud scheme that cost Medicare $9.5 million. The scam involved falsifying patient records to bill the government health care benefits program for a higher level of care that either wasn’t medically necessary or wasn’t provided.

The story states that the woman was paid more than $300,000 in bonuses by her company over a three-year period for placing patients on a more expensive, higher service level than needed. As a result, Medicare was grossly overbilled for patient services.

The 35-year-old fraudster was charged with four counts of health care fraud related to improper billing of hospice services and convicted on three counts, each carrying a punishment of up to 10 years each in prison. When the request was made for a new trial, court documents stated that the prior evidence was ”more than sufficient to support the jury’s verdicts on the counts of conviction.” (It looks like things didn’t quite go the way she had planned.)

Ironically, this case is relatively small considering a recent report that states hospice providers overbilled Medicare by $268 million in 2012. (Although a little here and a little there all add up to a lot over time.) Fortunately, the government has stopped this woman and her co-conspirators from further bilking taxpayers and the hospice company has been shut down. (Justice has been served twice. Case closed.)

Source: 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.

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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.