December 4, 2011

Doctor, People from Craigslist Posing as Docs Sentenced

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A New Jersey doctor has been sentenced to more than three years in prison after sending people posing as physicians to perform more than 20,000 patient visits.

Some of the people that Yousuf Masood, 47, of Warren, N.J., had pose as doctors were found on craigslist, said the U.S. Attorney’s Office in New Jersey. Masood paid the people rates as low as $10 an hour and “directed them to spend no more than five to 10 minutes with patients,” during which they would prescribe medications and order procedures.

Masood also has to pay more than $1.8 million in restitution and forfeiture that resulted from fraudulent Medicaid and Medicare billings, the U.S. Attorney’s Office stated. Others involved in the scheme were sentenced to probation.

In other fraud news:

  • A Southfield, Mich., doctor was sentenced to 10 years in prison after pleading guilty to conspiring to defraud the Detroit Public School system of more than $3.3 million as part of a wellness program. Gwendolyn Washington, 67, also performed unnecessary tests and had patients return to her office to repeat the tests, “even though initial results were normal,” according to the U.S. Attorney’s Office in Eastern Michigan. She billed Blue Cross and Blue Shield more than $5 million for the tests, which were “potentially harmful to patients” because of the frequency and radiation.
  • Washington also received kickbacks of up to $500 per patient from home health agencies after falsifying their eligibility for services, the U.S. Attorney’s Office in Eastern Michigan stated.
  • Two Panama City, Fla., physicians were charged in a 109-count indictment in connection with unlawful dispensing of controlled substances and health care fraud. The charges against Rudolfo Torres, 61, include one count of dispensing controlled substances resulting in the death of one person. The charges against Abdul Salman, 66, include one count of dispensing controlled substances resulting in the death of one person, according to the U.S. Attorney’s Office in Northern Florida.

    The indictment alleges Salman and Torres prescribed controlled substances without sufficient medical necessity; in quantities and dosages that caused their patients to abuse, misuse and become addicted; and knowing the patients were addicted and misusing the medications, the U.S. Attorney’s Office stated. The charges of unlawfully dispensing controlled substances resulting in death carry penalties of up to life in prison and a $1 million fine. Health care fraud charges carry penalties of up to 10 years in prison and a $250,000 fine.
  • A former Houston doctor has been sentenced to five years and 10 months in prison in connection with improper billing of codes related to laser ablation procedures. Armando Chavez, 42, directed his staff to bill individual steps in the procedures, “resulting in greater reimbursement and payment for each payment,” the U.S. Attorney’s Office in Southern Texas announced. He also must pay more than $3.8 million in restitution.
  • A Monroe, N.C., physician must pay $950,000 to settle false claims allegations that she upcoded at her gynecology practice, according to the U.S. Attorney in the Western District of North Carolina. Millicent Francis-Lane “billed Medicaid for more extensive services than she actually provided” from 2003 to 2009, the U.S. Attorney stated. The payment is double the amount she billed Medicaid.
  • A former senior manager at one of the largest home health companies in the country was sentenced to five months in prison and five months of home confinement for his role in a fraud scheme that cost the company $150 million in False Claims Act payments. Bryan Lee Shipman, 38, directed one of Maxim Healthcare Services’ unlicensed offices to bill for Medicaid reimbursement as if they were from another office that was licensed, according to the U.S. Attorney’s Office in New Jersey. Shipman said he “authorized and supervised the unlicensed operation” of the office because he felt pressured goals of increased company growth, the U.S. Attorney’s Office stated.
  • A Weslaco, Texas, former nurse was sentenced to 15 months in prison and ordered to pay more than $26,800 for submitting falsified documentation to her home health agency employer. Veronica De Leon, 34, submitted more than 375 falsified patient visit forms and asked her patients not to report her to her employer, including asking one patient to lie to her employer for her, according to the U.S. Attorney’s Office in Southern Texas.
  • New Milford (Conn.) Hospital will pay $471,933 to resolve False Claims Act allegations involving improper billing for injections of leuprolide acetate. Different doses of the drug, which has a brand name of Lupron or Lupron Depot, treat prostate cancer in men and endometriosis and fibroids in women. The hospital billed the higher-paying female billing code for male patients and received higher reimbursement, the U.S. Attorney’s Office in Connecticut stated.

    The hospital discovered the error, conducted an internal audit and determined the amount of the overpayment but did not repay the money to Medicare, which it must do in 60 days, the U.S. Attorney’s Office stated.

About the Author

Karen Long is the compliance product manager for DecisionHealth and oversees products that relate to fraud and abuse and HIPAA compliance for physician offices and home health agencies, and accreditation compliance for hospitals. In her almost four years at DecisionHealth, Karen also has been the compliance editor and a reporter for Home Health Line, nation's leading independent authority on home healthcare business, regulation and reimbursement.

Contact the Author

KLong@decisionhealth.com

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