Whistleblower Accuses Hospice Corp. of Medicare Fraud

A former Vitas Healthcare Corp. manager has accused the hospice chain of defrauding the federal government by conspiring with health insurers to enroll Medicare patients who weren’t dying.

Vitas, a unit of Cincinnati-based Chemed Corp. (CHE), is the largest U.S. provider of hospice care, which has attracted government scrutiny as its Medicare-covered patients have doubled to 1.1 million over the last decade.

Chemed fell 15 percent, the most since April 2008, to $49.10 at 10:37 a.m. in New York.

The allegations came in a lawsuit unsealed last week in U.S. District Court in Dallas. Vitas spokeswoman Kal Mistry said the company “cannot comment on pending litigation.”

In the same court, the Department of Justice is seeking internal Vitas documents in an investigation focused on alleged abuses of federal health-insurance programs. The government has told the court it suspects Vitas of “an extensive scheme” to defraud Medicare and Medicaid of “hundreds of millions of dollars” by falsifying records and hospice certifications.

Vitas has “consistently been in compliance with Medicare and Medicaid rules,” Mistry said.

The newly unsealed suit was filed by Michael Rehfeldt, a former branch manager for Vitas in San Antonio, who is seeking damages for the government as a whistleblower under the U.S. False Claims Act, which entitles him to part of any recoveries. Such claims are also called qui tam suits.

“False certifications, fraudulent billing and cost shifting to the United States constitute a widespread, systematic practice endemic to Vitas,” Rehfeldt’s suit alleges.

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Whistleblower Accuses Chemed Unit of Medicare HMO Conspiracy

Senate Special Committee on Aging Holds Hearings on Assisted Living Facility Abuse

It was an early-morning awakening that Alfredo Navas said he’ll never forget: His sister on the phone, telling him that their 85-year-old mother had drowned in a shallow drainage pond behind the facility that was caring for her.

But the safeguards his family had assumed were in place to monitor an elderly woman with dementia – cameras, door locks and vigilant caretakers – failed his mother in 2008, Navas told the Senate’s Special Committee on Aging on Wednesday [11/2/11].

Those abuses and others were chronicled in a Miami Herald series “Neglected to Death,” which focused this spring on critical breakdowns in Florida’s enforcement system, including failures by the state’s Agency on Health Care Administration to fully investigate deaths or to shut down some of the worst offenders among Florida’s 2,850 assisted-living facilities.

“This is America in the year 2011, and these kind of things shouldn’t be happening,” said Sen. Bill Nelson, D-Fla., who read aloud of the worst examples of abuse.

They include a 75-year-old Alzheimer’s patient in Clearwater torn apart by an alligator after he wandered away from his assisted-living facility for the fourth time; a 71-year-old mentally ill Hialeah man who died from burns after he was left in a bathtub filled with scalding water; and a 74-year-old Kendall woman who was restrained for six hours until the bindings cut into her skin and killed her.

Federal regulators and lawmakers both said that they are uninterested in the federal government being responsible for regulating living facilities. Although more states are using Medicaid money to pay for some portion of assisted living care for the poor, the federal government has a limited role in the facilities their oversight has been and will likely continue to be a state duty.

But federal regulators do want more of an ability to ensure states are doing their part to enforce laws and safety regulations already on the books, said Barbara Edwards, who directs the disabled and elderly health programs group at the Centers for Medicare and Medicaid Services at the Department of Health and Human Services.

Full Article and Source:
Abuses in Assisted Living Facilities Come Under Senate Panel’s Spotlight

Probate Sharks: Watch This Case Very Carefully

Editor’s note:

Heard in the shark tank: This case in U.S. Federal Court, while not very great monetarily, is important for its content. Apparently, the Chicago FEDS are now moving against the fraudulent Medicaid, Medicare and Probate Cartels. We sharks have our suspicions as to the identity of “Individual A and Agency A”. If our suspicions are true and correct, a turning point of monumental importance has been reached in the war against the Probate Court Terrorists.

United States of America vs. Jay Canastra

~Lucius Verenus, Schoolmaster, ProbateSharks.com

Source:
ProbateSharks

GA Doctor Sentenced to Prison for Bilking Medicaid/Medicare

Dr. ROBERT WILLIAMS, 77, of Atlanta, Georgia, was sentenced to prison by United States District Judge Richard W. Story on federal health care fraud charges.

United States Attorney Sally Quillian Yates said, “This doctor attempted to bilk Medicare and Medicaid for over $2 million for psychological services he never provided to elderly nursing home patients. Some of the patients were dead at the time he claimed he provided services; others never received treatment. Now he’s headed to prison.”

“Many of Georgia’s neediest citizens rely on Medicaid for access to health care. The Attorney General’s office is committed to weeding out fraud so that every dollar is spent on those who need this vital assistance,” said Georgia Attorney General Sam Olens.

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Doctor Sentenced to Prison for Submitting Fraudulent Bills to Medicare and Medicaid

>Seniors a Top Target for Health Care Fraud and Abuse

>Instead of fading away over the years, the business of defrauding the government of billions of dollars annually is not only still going strong, but is increasing, according to the most recent report from the Health Care Fraud and Abuse Program.

And Baby-Boomers beware: You’re not only at the top on the list for fraud and abuse, but for medical errors as well. Meanwhile, certain parts of health care reform from the government level appear to be more rhetoric than action.

From over-pricing and false claims for medical services, to gross misconduct and mismanaged care of senior citizens in nursing homes, the pharmaceutical industry leads the pack in health care fraud and abuse. It’s been that way for decades. That’s why the U.S. government has repeatedly enacted new laws – in 1986, 1996, 2009, and 2010 – to crack down on offenders.

The 1986 legislation strengthened a Civil War-era fraud law, the False Claims Act, with incentives for private citizens to report fraud and abuse of government programs by corporate America.

This law enabled “whistleblowers” to expose corporate criminals whose crimes had previously gone undetected. But it didn’t stop these crimes, so, in 1996, Congress created another enforcement tool, the Health Care Fraud and Abuse Control (HCFAC) program, which provides for huge fines and prison sentences for health care fraud and abuse.

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Seniors a Top Target for Health Care Fraud and Abuse

>Medicare to Fund End-of-Life Planning Consultations With Physicians

>Medicare will now fund end-of-life health care planning consultations. Pre-planning, family discussions of these (end-of-life) issues, won’t ease the pain of dealing with medical crisis; what is does do is lay the groundwork for making informed decisions based on what the patient really wants, what the patient’s priorities and beliefs require. It is a road map through both crisis and longterm care.

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Medicare to Fund End-of-Life Planning Consultations With Physicians

>FL: Medicare Money Paid for Posh Life

>Lawrence Duran and Marianella Valera loved spending taxpayers’ money.

So much so, that the $84 million Medicare paid their Miami-based chain of mental health clinics for bogus therapy is practically gone, authorities say.

“As of right now, we can only locate $150,000” in the couple’s bank accounts, Justice Department attorney Jennifer Saulino said in Miami federal court Thursday.

So, where did all the money go?

It was spent on hefty salaries, foreign cars, fancy jewelry, international travel, a bayfront condo, even tuition for Duran’s children at Belen Jesuit Preparatory School and Chaminade-Madonna College Preparatory, court records show.

Prosecutors said the defendants, charged with bilking the taxpayer-funded Medicare program, have ‘dissipated” $77 million in government payments.

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Medicare Money Paid for Posh Life

Former Doctor Sentenced to 5 Years Probation for Nearly $750,000 Theft

A former podiatrist who admitted to defrauding the health care system will not go to prison.

Michael Akyuz of Greece was sentenced to five years probation despite stealing almost three-quarters of a million dollars.

U.S District Court Judge Charles Syragusa called it a unique, exceptional family circumstance that led him to impose a lesser sentence today.

The recommended sentence for his crimes was 41 to 51 months in prison, but 44-year-old Akyuz will not have to spend a day behind bars.

Akyuz admitted to health care fraud and mail fraud while he was a podiatrist. Over the course of five years, the former foot doctor tended to elderly patients in nursing homes and retirement communities. While he billed Medicare for complex expensive procedures, in reality, he did little more than clip their toe-nails.

The total cost to tax-payers was almost three-quarters of a million dollars.

Akyuz said he took the money to take care of his family’s health care costs. He has four children with varying degrees of autism.

Akyuz will also have to make restitution.

Full Article and Source:
I Team 10 Update: Former Foot Doctor Avoids Prison

Florida: Medicare Scammer Gets 20 Years

Just days after his partners in crime were arrested on Medicare fraud charges, Ihosvany Marquez was recorded on an undercover tape saying he had no qualms about stealing from the federal program for the elderly and disabled.

“I don’t care because it is the government,” Marquez told a federal informant, pitching him on a plot to export a multmillion-dollar scam from Miami-Dade to Detroit.

“Medicare needs to have fraud because it’s more money they get every year,” he said in the May 27, 2009, recording, which was read Thursday by a prosecutor in Miami federal court.

Marquez, a former Miami Springs High pitching ace who almost played in the Major Leagues, was sentenced Thursday to 19 ½ years in prison for healthcare fraud. He schemed to bilk $48.8 million from Medicare by submitting false claims for purported HIV therapy.

Marquez’s seven clinics in Miami-Dade and Orlando were paid $21.6 million, which he must repay the taxpayer-funded Medicare program.

Full Article and Source:
Convicted Miami Dade Medicare Scammer Imprisoned for Nearly 20 Years

Are Regulators Cracking Down on Elder Abuse Medicare Fraud?

California State health insurance regulators are cracking down on insurance brokers who prey on elderly consumers confused by new federal health insurance rules.

On Tuesday, the Department of Managed Health Care took steps to bar a Folsom insurance agent from selling Medicare Advantage plans after she allegedly defrauded at least 12 capital-area seniors, who then incurred thousands of dollars in unexpected medical bills.

The agent, identified by state officials as Nadia King, allegedly canceled the existing Medicare coverage of her clients and enrolled them in Medicare Advantage plans run by private insurers.

King could not be reached for comment. She has until the end of the month to appeal the decision to revoke her privilege to sell Medicare Advantage products.

She is one of two dozen agents across the state getting legal scrutiny because of what officials said was deceptive marketing aimed at seniors.

Full Article and Source:
Are Regulators Cracking Down on Elder Abuse Medicare Fraud?