Expecting Fraud

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The average life expectancy in the United States is on the rise. As the population ages, additional assistance is needed for those who can no longer manage their lives independently, or just want to get out of the house for some mental and social stimulation. Adult day care centers often provide physical and mental health care services, as well as social opportunities for adult citizens who are unable to take care of themselves or feel isolated or lonely, while providing a break for caregivers. However, the Department of Justice (DOJ) reports that the owner of a Michigan adult day care center was doing more than just arts and crafts and musical sing-a-longs with the participants at his center. He was also billing Medicare for $3.2 million of mental health services that were never provided.

A DOJ press release states that the owner and operator of the adult day care center billed Medicare for individual and group psychotherapy services. His patients were mentally disabled residents from the Flint area, who lived in adult foster care homes. He also lured in people who were seeking narcotic drugs by promising they could see a doctor at the center who could write prescriptions for them, if they signed up for the psychotherapy program.

The owner and operator did not act alone. He had a few co-conspirators. He directed center employees and social workers to create false patient records and progress notes indicating that psychotherapy services were being provided, even though they were not. The fraudster and his employees also convinced the center participants to pre-sign sign-in sheets for months in advance and then used the sign-in sheets to bill Medicare. In some instances, the center billed Medicare for social workers that supposedly provided over 24 hours of care in a single day. Over a two-year period, the adult day care center billed for approximately $3.2 million and received more than $988,000 from Medicare.

The 53-year-old owner was found guilty of one count of conspiracy to commit health care fraud and seven counts of health care fraud for directing a psychotherapy fraud scheme. He is facing a maximum sentence of 80 years in prison. A 67-year-old social worker, who was the center program coordinator, was also found guilty of one count of conspiracy to commit health care fraud. He faces a maximum sentence of 10 years. A third defendant is awaiting trial.

Adult day care centers such as this one are meant to be a safe place where adults, who need assistance, can socialize, relax, participate in enjoyable activities and receive needed services. Criminals, who take advantage of those who are mentally challenged or drug-dependent, are preventing those Medicare beneficiaries who truly need assistance from getting the help that they need. Thankfully, the Medicare Strike Force has acted as an advocate for these victims and prevented any further criminal action.

Source: Today’s ”Fraud of the Day” is based on the press release titled, ”Operators of Michigan Adult Day Care Center Convicted in $3.2 Million Medicare Fraud Scheme,” released by the Department of Justice on October 18, 2013.

DETROIT – A federal jury in Detroit today convicted the owner and the program coordinator of two Flint, Mich., adult day care centers for their participation in a $3.2 million Medicare fraud scheme.

Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney Barbara L. McQuade of the Eastern District of Michigan; Acting Special Agent in Charge John Robert Shoup of the FBI Detroit Field Office; and Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Detroit Office made the announcement.

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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.