Old-fashioned Idea, Newfangled Fraud

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Physiotherapist giving physical therapy to senior male patient in clinic

Physician house calls are an old-fashioned idea, but Medicare has turned to them to help the government health care program save money in the 21st century. While a key study shows that home health care has saved 17 percent in health care spending by reducing the need to visit a hospital or be admitted to a nursing home, it has also opened the door for nefarious physicians to seek undeserved Medicare reimbursements through this newfangled fraud. Today’s fraudster received $17.1 million in illegal reimbursements from a scheme he carried out in Michigan.

The physician in today’s case billed Medicare for home visits that were between 40 and 60 minutes long and at the highest billing code possible. But he only spent 15 minutes or less with each patient. (This allowed him to bill up to 22 home visits per day. A reasonable number of visits per day is between 5 to 7, including travel time.) He also ordered unnecessary tests for patients who did not need them to qualify for bigger bonuses from Medicare. (The more money a mobile physician service saves Medicare, the bigger the bonus paid out.)

 The 40-year-old doctor, who worked for the mobile physician company for more than a decade, was found guilty of one count of conspiracy to commit health care fraud after a two-week trial.(Two other doctors who testified at this fraudster’s trial previously pleaded guilty to conspiring to commit health care fraud in connection with the scam.)

Considering that this physician could make anywhere from $60 to $210 per visit depending upon the severity of the patient’s condition, you can see why mobile physician fraud is lucrative. While home visits help to reduce expensive emergency room visits, hospital readmission and enable patients to be monitored more easily for diabetes, asthma and high blood pressure, the government has to keep a watchful eye on the potential for fraud. Congrats to the Medicare Strike Force for bringing down yet another industrious fraudster. (Instead of making house calls to patients, this man will probably be making a personal visit to the Big House.)

Source:Today’s “Fraud of the Day” is based on an article entitled, “West Bloomfield doctor guilty in Medicare fraud scheme” published by The Detroit News on May 9, 2017.

A West Bloomfield Township physician has become the third doctor convicted in a $17.1 million Medicare fraud scheme in Michigan.

Dr. Gerald Daneshvar, 40, was found guilty Monday of one count of conspiracy to commit health care fraud after a trial of about two weeks, the U.S. Department of Justice said in a news release. He was acquitted of two counts of health care fraud.

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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.