Infusion Fraud

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54221462 - medical syringe in the doctor's hands on the patient's background.

Medicare fraud costs taxpayers and the federal government billions of dollars each year, while also threatening the lives of patients and compromising the nation’s healthcare system. Today’s “Fraud of the Day” article focuses on an Orlando-area medical doctor and an infusion clinic owner who masterminded a Medicare fraud scam that attempted to steal $13.8 million by submitting fraudulent bills to the government healthcare program and private insurance companies.

Infusion therapy usually provides the administration of medication intravenously through a needle or catheter and is prescribed when a patient’s condition is unable to be treated effectively with oral medications. It can also be provided through intramuscular injections and by epidural. (Sounds painful, but necessary for those who truly need the medication.) Drug therapies administered via this route include antibiotics, chemotherapy and antifungal or antiviral medication. It can also be used to hydrate, manage pain and provide nutrition.

The physician was the medical director of four Orlando-are infusion clinics that treated Medicare beneficiaries. The doctor and the infusion clinic owner submitted false claims to Medicare and private insurance companies for pricey infusion therapy medications. This included anticancer chemotherapeutic medications that were never administered. (Think about the people who may have needed the drugs, paid for them, but never received them.)

Over three years while the physician was medical director, he and the infusion clinic owner were responsible for the submission of $13.7 million in bogus claims to Medicare and other private insurers. (Medicare paid $9.8 million.) They also submitted claims stating that physical therapy had been provided to patients at the infusion clinics, even though there was no licensed physical therapist at any of the four clinics.

Both men pleaded guilty to one count of conspiracy to commit healthcare fraud. The 60-year-old medical doctor from Gotha, Florida was sentenced to 64 months in prison and two years of supervised release. The 40-year-old infusion clinic owner from Winter Park, Florida was sentenced to 90 months in prison plus another two years of supervised release. Both fraudsters must also pay $9.8 million in restitution and forfeit the same amount. As part of a plea deal, the infusion clinic owner agreed to the forfeiture of $1.7 million in real property.

These two fraudsters from Florida were trying to infuse their bank accounts with government funds intended for Medicare patients who needed infusion to fight maladies. Congratulations to the Medicare Strike Force for pulling the plug on these deceptive providers and shutting down this Medicare fraud scheme.

Today’s “Fraud of the Day” is based on a Department of Justice press release entitled, Orlando Doctor and Infusion Clinic Owner Sentenced to 64 Months and 90 Months in Prison for Role in Medicare Fraud,” released on June 26, 2017.

An Orlando medical doctor and an infusion clinic owner were sentenced to 64 months in prison and two years supervised release, and 90 months and two years supervised release, respectively, today for their roles in a $13.7 million Medicare fraud conspiracy that involved submitting claims for expensive infusion-therapy drugs that were never purchased, never provided and not medically necessary.

Acting Assistant Attorney General Kenneth A. Blanco of the Justice Department’s Criminal Division, Acting U.S. Attorney Stephen Muldrow of the Middle District of Florida and Special Agent in Charge Shimon R. Richmond of the U.S. Department of Health and Human Services-Office of Inspector General’s (HHS-OIG) Miami Regional 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.