The OIG Cracks Down On Fraud and Abuse Cases

The OIG excludes almost 1,500 individuals and entities for fraud and abuse-related crimes. In its most recent Semiannual Report to Congress for October 1, 2008 to March 31, 2009, the OIG includes in its summary of accomplishments “exclusions of 1,415 individuals and entities for fraud or abuse involving Federal health care programs and/or their beneficiaries” resulting in over $2 billion in receivables. The OIG describes in more detail its criminal and civil enforcement involving, in part, false filing claims for reimbursement against Medicare, Medicaid, and other Federal health care programs. To resolve false claims, the OIG partners with the FBI, Medicaid Fraud Control Units (MFCU), as well as other law enforcement agencies. MFCU assists the Government in detecting, prosecuting, and punishing fraudulent activity against Medicaid programs by investigating and prosecuting “providers charged with defrauding the Medicaid program or abusing, neglecting, or financially exploiting beneficiaries in Medicaid-sponsored facilities.” The OIG report summarizes “notable enforcement actions” in its report including a hospice in Alabama, a medical transcription service provider in Massachusetts, a physician in California, and a durable medical equipment (hereinafter “DME”) company in Texas.

In Alabama, SouthernCare, Inc; SouthernCare Holdings, Inc.; SouthernCare Carry, L.L.C.; and Michael Pardy allegedly submitted false claims to Medicare. This finding resulted in the entities paying $24.7 million for “treating patients who did not meet Medicare’s hospice eligibility criteria.”

In Massachusetts, MedQuist, Inc. allegedly overbilled the Department of Veterans Affairs, the Department of Defense, and the Public Health Service for “medical transcription services by inflating the number of lines billed to the Government instead of applying the contractually prescribed method.” The settlement resulted in $6.6 million to the United States.

A California physician, Paul Lessler, allegedly “allowed his UPIN to be used to bill Medicare for respiratory therapy.” Additionally, he is alleged to have billed for the claims incident to his services when he did not directly supervise the procedures, suggesting that the services were performed at his office as opposed to the “noncovered board and care facilities.” He is also alleged to have paid kickbacks to marketing personnel who recruited patients to him. Dr. Lessler agreed to pay $2.18 million and to be excluded for 15 years.

Finally, in Texas, a Ihem Wilson and Theresa Peter allegedly owned and/or operated Access Medical Supply, “a DME company that billed Medicare for motorized wheelchairs” that often “provided less expensive motorized scooters.” As a result of a 35-count indictment, Wilson plead guilty to health care fraud and wire fraud and was sentenced to almost 6 years in prison and required to pay $3,217,579. Peter, a co-conspirator, was required to spend about 1 year in prison and to pay $1,582, 277 (this sentence came in July of 2008).

For more information, please call Adrienne Dresevic, Esq. or Carey F. Kalmowitz, Esq. at (248) 996-8510 or visit The HLP website.