A Big Catch in the Big Easy

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How many fraudulent Medicare claims is too many? (The correct answer should be only one.) According to The Advocate, two doctors and one nurse employed by a New Orleans area home healthcare business submitted approximately 8,000 fraudulent claims to Medicare. Their criminal efforts were part of a $50 million scheme that occurred over the course of a decade.

According to the story, the fraud was perpetrated through multiple healthcare companies owned by one man. The ruse involved kickbacks paid to co-conspirators who recruited phony patients and the submission of thousands of bogus Medicare claims by employees. (The beneficiaries were falsely certified as homebound and in need of health services and equipment.)

The most recent fraudsters convicted in this case are two doctors and one nurse, all in their 60s. (Wisdom does not always come with age.) One 69-year-old male doctor expressed remorse for his actions and received a reduced five-year prison sentence due to health problems. He will pay $5 million in restitution. The other 67-year-old female doctor readily admitted she was motivated to commit the crime because of money. She must serve six and a half years in prison and pay $9.5 million in restitution. (She cited that a drinking problem seriously impaired her ability to reason. I’m guessing she also had difficulty in treating her patients as well.) The 67-year-old nurse, who shuttled more than 500 Medicare patients through the operation, received a 50-month sentence and will pay $2 million in restitution. (Apparently, she was stunned by the sentence, claiming she knew nothing about what was going on during her 10 months of employment.)

The owner, who pleaded guilty, currently awaits sentencing. A former office manager was sentenced to four years in prison for filing false claims. Nine other defendants in this case have already pleaded guilty.

This case was investigated by the Medicare Strike Force, an effort which combined the investigatory prowess of the Federal Bureau of Investigation, U.S. Department of Health and Human Services, and the Louisiana Attorney General’s Office. This story shows that when Medicare is defrauded on any scale – whether large or small – the responsible parties will be punished. (Congratulations to the Medicare Strike Force for discovering this huge conspiracy in the Big Easy and making it harder for other criminals to get away with defrauding the government in the future.)

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Two New Orleans-area doctors, one nurse sentenced to years in prison in Medicare fraud case,” written by John Simerman and published by The Advocate on December 16, 2015.

Neither their age nor their decades of work in health care spared two local physicians and a nurse from lengthy federal prison terms Wednesday for their roles in what prosecutors describe as a $50 million Medicare fraud scheme, although a judge handed each of them shorter terms than federal guidelines suggested.

U.S. District Judge Sarah Vance gave a five-year sentence to Dr. Roy Berkowitz, 69, of Slidell and a 6 1/2-year sentence to Dr. Barbara Smith, 67, of Metairie. Vance sentenced New Orleans nurse Beverley Breaux, 67, to more than four years.

All three, along with office manager Jo Ann Murthill, 58, of New Orleans, who was sentenced last month to four years in prison, were convicted in a May trial of defrauding the government by filing false claims on thousands of Medicare recipients who they certified were homebound and needed health services and equipment.

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