Recycling Patients

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52342343 - nurse taking care of sick elderly patient at home

There’s no doubt that recycling is good for the environment. It helps to reduce trash that fills landfills, uses old stuff to make new stuff, and saves money, natural resources and energy. A nurse mentioned in a Home Health Care News article took recycling to a whole new level at the home health agencies where she worked. (She tried to recycle her patients in order to illegally obtain millions in Medicare insurance reimbursements.)

The story states that the nurse, who helped run three home health care businesses located in Illinois, was one of more than a dozen people indicted for their involvement in a $45 million fraudulent Medicare scheme that transpired over six years. (The scheme claimed that Medicare beneficiaries needed the overpriced home health care, when in reality they did not.)

The nurse at the center of today’s ”Fraud of the Day” instructed other nurses to falsely certify patients for in-home skilled nursing care. She also participated in ”patient recycling” where she approved releasing patients from care, then later re-enrolled them.

Apparently, this woman’s illegal acts are just the tip of the iceberg, or patient recycling heap. The scheme also involved the company co-owners – considered to be the masterminds, a former director of nursing, a patient recruiter and several other nurses. The nurse and six others, who have pleaded guilty, are scheduled to go to trial. (While it remains to be seen what sentence this fraudster and her co-conspirators will receive for their illegal actions, it’s a sure thing that the Justice system will take into account the fact that this fraudster’s inefficient recycling efforts certainly did not save Medicare any time, money or resources.)

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”Nurse Fraudster Pleads Guilty in $45 million Home Health Scheme,” published by Home Health Care News on September 14, 2016.

Following a months-long investigation of three, Illinois-based home health agencies, a nurse who helped run the companies has pleaded guilty to her role in a Medicare fraud scheme totaling $45 million, according to court documents.

Administrator and director of nursing at Donnarich Home Health Care Inc., Pathways Home Health Services LLC and Josdan Home Health Care Inc., Sharon Gulla admitted that she instructed nurses to falsely certify patients for in-home skilled nursing to reap millions in insurance reimbursements.

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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.