Posts Tagged ‘Medicare Fraud’
There’s a Fine Line Between Criminal and Civil Healthcare Fraud
There’s a fine line that exists between many civil and criminal matters, such as healthcare fraud or Medicare fraud. As the case below discusses, that line is often as simple as whether the alleged wrongdoer was “willful” in his/her actions.
Connecticut Law Tribune: Hospital Settles Claims That It Overcharged Medicare
The U.S. government and Johnson Memorial Hospital in Stafford Springs entered into a civil settlement agreement late last month to resolve allegations that the infirmary violated the False Claims Act.
The U.S. Attorney’s Office in Connecticut alleges that Johnson Memorial Hospital overcharged Medicare for infusion therapy, chemotherapy administration, and blood transfusions between 2000 and 2005.
During this period, Medicare authorized payments for one unit of infusion therapy (in which a drug is administered intravenously) and chemotherapy administration per patient visit. Also, only one unit of blood transfusion service was permitted per day. However, on many occasions, Johnson Memorial Hospital billed Medicare for between two and eight units per patient visit, according to the U.S. Attorney’s Office.
“Billing for inflated charges relating to chemotherapy, infusion, and blood transfusion services siphons critical resources away from the Medicare program, which relies on hospitals to bill Medicare honestly and accurately,” acting U.S. Attorney Nora Dannehy said in a statement. “Health care fraud is a national problem that the United States Attorney’s Office is devoted to combating.”
Johnson Memorial Hospital, which declared bankruptcy in 2008, agreed to settle the civil dispute by reimbursing Medicare $191,193. By settling the case, the hospital does not admit any liability. The hospital will immediately pay $95,596 of the amount and then pay the remainder over a two year period plus interest.
“What happened here is an honest mistake,” Peter J. Betts, the hospital’s interim president and CEO recently told the Hartford Courant. “There are hundreds of billing codes that you use when you bill Medicare, and if you happen to pick the wrong code, you can be overpaid or underpaid. We would not knowingly overbill.”
If you are being accused of willfully violating the law, contact the legal defense team at The McKellar Law Firm, PLLC, today at 865-566-0125 for a free consultation. For a Tennessee Healthcare and Medicare attorney, click here.
Former Hospital Owner Sentenced to 37 Months for Medicare Fraud
Ex-LA hospital owner sentenced for Medicare fraud – washingtonpost.com
LOS ANGELES — A former Los Angeles hospital owner was sentenced Monday to more than three years in federal prison for paying kickbacks to recruit patients from among the homeless on Skid Row, authorities said.
Robert Bourseau, 75, was sentenced to 37 months in prison and ordered to pay $4.1 million in restitution for defrauding Medicare and Medi-Cal, as Medicaid is known in California. He pleaded guilty in June to paying illegal kickbacks to defraud the government health care systems.
U.S. District Judge George H. King said that such schemes “degrade the health care system, all because of greed and money.”
“Society must know that those who abuse the health care system must answer for that conduct in court,” the judge said.
Bourseau, who has homes in downtown Los Angeles and in Rancho Mirage, co-owned the now-defunct City of Angels Medical Center.
Federal prosecutors contended that Bourseau and the hospital’s co-owner, Dr. Rudra Sabaratnum, paid a recruiter $500,000 between 2004 and 2007 to recruit Skid Row denizens to undergo unnecessary hospital stays, then billed the government for their care.
The patients then received a small payment, typically less than $100, according to a statement from the U.S. attorney’s office.
Sabaratnum, 65, of Los Angeles, pleaded guilty in 2008 to paying kickbacks and is scheduled to be sentenced on April 5. Both men agreed last month to pay $10 million to settle a state and federal fraud lawsuit.
Two others who pleaded guilty await sentencing: Dante Nicholson, the hospital’s former senior vice president, and the recruiter, Estill Mitts.
Mitts, who ran a Skid Row assessment center, said he earned about $20,000 a month in kickbacks and was delivering between 30 and 50 patients a month. He pleaded guilty to conspiracy to commit health care fraud, money laundering and tax evasion.
