Archive for the ‘Medicaid Fraud’ Category
A Chisago County resident was prominently featured in stories by metro news outlets last year, describing her legal ordeal contesting end-of-life measures for her 85-year-old husband. In recent months, though, the story has expanded from a tale of human emotion to include alleged Medicaid fraud. Franconia Township resident Lana Barnes, is facing seven criminal charges of theft by false representation. She is accused of taking more than $100,000 from the system designed to compensate attendants who provide care for the seriously ill in their home. Barnes, (who turns 58 on Jan. 17) rather unceremoniously lost her guardianship rights in early 2011 concerning her frail husband Al.
The probate court reacted to Barnes having altered Al’s medical care directive papers, omitting two pages of the 1993 directive when she presented the papers to a hospital in December 2010. The statements omitted were contradicting her assertions that he’d stipulated aggressive, life sustaining care. The theft charges came March 2012 as a result of Chisago County Public Health and Human Services staff and state officials in the Medicaid Fraud Control Unit of the MN Attorney General looking into paychecks for Al Barnes’ personal care attendant (PCA). According to the criminal complaint Lana Barnes intentionally mis-represented to Nurse Staffing Solutions that her son Fred had provided personal nursing services for Al. Spouses are not permitted under Medicaid to collect wages as a PCA.
Other family members may, however, qualify as a PCA. The problem was that the son Fred, an over-the-road truck driver, was not at home on Quinlan Avenue but was driving when his PCA timesheets claimed hours from Nurse Staffing Solutions. PCA providers like Nurse Staffing Solutions, administer the attendants’ participation in the program and distribute wages to approved PCAs. The complaint also alleges that Chisago County social workers were concerned that some of the PCA hours submitted overlapped with when Al was hospitalized. Medicaid does not cover costs for a PCA when the client is hospitalized. The complaint alleges Barnes’ timecards covering about $22,000 in pay, between July 2009 and May 2010, coincided with Al’s hospital stays.
The complaint declares that when the state investigator contacted Fred he said he had been accepted as his father’s PCA in 2005. By 2006 he was driving truck, and his mother managed all the paperwork relating to his father’s care. Fred denies completing, signing or submitting any PCA time cards. He reportedly told the fraud unit investigator he knew Lana Barnes was receiving his PCA paychecks and he should not have let this continue, the complaint states. “Overpayments” based on Fred’s trucking logs and company payroll records between Jan. 2007 to May 31, 2010 amounted to $100,973. Due to the complexities of this case and the amount of the alleged fraud, Chisago County Attorney Janet Reiter said prosecution is being handled by the state, in court proceedings in Center City.
Shocking Surprise in Al Barnes Case!
The rise of for-profit nursing homes is proving tragic for some of the nation’s most vulnerable people, resulting in a spike in waste, fraud and abuse charges brought by federal authorities, according to a new report.
An investigation of government data and court filings from Bloomberg News reveals horrifying circumstances at these facilities: A 92-year-old lung cancer patient given physical therapy after spitting up blood. An 80-year-old woman who couldn’t support her own head forced into a “standing frame” for over an hour. An unattended 77-year-old patient who choked on her dinner.
The profit motive is having an outsize affect on quality of care, according to Bloomberg, which obtained U.S. government data through Freedom of Information requests. “Thirty per cent of claims sampled from for-profit homes were deemed improper, compared to just 12 percent from non-profits,” according to the article.
Seventy percent of nursing homes were operated on a for-profit basis in 2010, according to an audit by the Medicare Payment Advisory Commission, which counsels Congress. For-profit nursing homes perform better financially: Their profit margins from treating Medicare patients were 21 percent in 2010 compared to 10 percent for non-profit nursing home companies, the commission reported.
Cases filed against the firms by law enforcement and by families of patients who died allege that for-profit nursing home companies pressure facility managers to minimize the number of employees and keep down their hours to save costs. At the same time, these firms push for patients to receive services they may not need, according to the allegations cited by Bloomberg.
Full Article & Source:
For-Profit Nursing Homes Fuel Rise In Fraud And Abuse Charges
A psychiatrist who lives in Skokie is being sued for orchestrating what federal authorities are calling the largest prescription fraud case ever in Chicago.
The defendant, Dr. Michael J. Reinstein, received illegal kickbacks from pharmaceutical companies and submitted at least 140,000 false claims to Medicare and Medicaid for antipsychotic medications he prescribed for thousands of mentally ill patients in area nursing homes, according to a civil health care fraud lawsuit filed today.
Reinstein also submitted at least 50,000 claims to Medicare and Medicaid, falsely stating that he provided “pharmacologic management” for his patients at more than 30 area nursing homes and long-term care facilities, the lawsuit alleges.
The lawsuit seeks triple damages under the False Claims Act, plus a civil penalty of $5,500 to $11,000 for each alleged false claim.
“This is the largest civil case alleging prescription medication fraud against an individual ever brought in Chicago,” said Gary S. Shapiro, Acting United States Attorney for the Northern District of Illinois.
Full Article and Source:
Doc Sued in Huge Prescription Fraud Case
Rita Hunter, former Jasper County public administrator, pleaded guilty to document fraud today [Nov 6] in U.S. Federal Court in Springfield.
Hunter, 60, who served a single term as administrator ending in 2008, entered a plea to the charge related to illegally obtaining federal benefits, that was contained in a Dec. 14, 2011 federal indictment.
By pleading guilty, Hunter admitted to a scheme involving a total fraud of $70,000 to $120,000, according to a release from the federal court. She directed her employees to submit materially false Medicaid applications for wards under the custody of the public administrator’s office. The applications falsely stated the wards had assets below the $1,000 threshold to be eligible to receive Medicaid benefits, when in fact the wards had assets of more than $1,000.
Under federal statutes, Hunter is subject to a sentence of up to five years in federal prison without parole, plus a fine up to $250,000 and an order or restitution.