Two Detroit-area residents have pleaded guilty to participating in a $13.8 million home health care fraud and money laundering scheme that sounds like a case study of the different types of healthcare fraud that can occur.
The defendants and co-conspirators owned or controlled four different home health care agencies that billed Medicare for home health visits that never occurred. Payments were made to various medical professionals, including doctors, nurses, physical therapists and physical therapy assistants, to create fictitious patient files to document purported home health services that were never provided. One of the defendants, a physical therapy assistant, also signed fictitious patient files in which physical therapy services were documented, but never actually provided.
Kickbacks were paid to recruiters who obtained beneficiaries’ information and used the information to submit claims for home health services that were never provided. The beneficiaries sometimes pre-signed forms and visit sheets that were later falsified to indicate that they received home health services that were never provided. Other times, the beneficiaries’ signatures were forged on forms and visit sheets.
At least one shell company was incorporated for the purpose of laundering the proceeds of health care fraud, which were obtained through the submission of false and fraudulent claims to Medicare.
Other corporations were formed that employed individuals who claimed to be doctors, but, in fact, were not licensed in the state to perform any medical services. The unlicensed doctors met with and purported to examine Medicare beneficiaries for home health care services. In fact, the patients were not examined, nor were they homebound. Many of the beneficiaries were paid to pre-sign patient visit forms and did not receive home health services at all.
Click here to read the full press release from the U.S. Department of Justice.
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