November 15, 2011

Fraud Report: Two Cases Underscore Fed’s Focused Efforts to Reduce, Prevent Medicare and Medicaid Fraud

By

m-spiveyWASHINGTON, D.C. – The Nashville-based Vanguard Health Care and its wholly owned subsidiary, Vanguard Health Care Ancillary, have agreed to pay the United States and the state of Tennessee a total of $2 million to settle False Claims Act allegations, according to Jerry E. Martin, U.S. Attorney for the Middle District of Tennessee.

The settlement resolves claims that Vanguard wrongly billed Medicare for enteral feeding services and supplies for patients in nursing homes that also had been billed to the Tennessee Medicaid program, authorities said. The settlement additionally resolves allegations that Vanguard wrongly billed Medicare for enteral feeding supplies that it received for free, and for allegedly billing Medicare for patients who were not eligible for the skilled nursing in-patient benefit, according to the investigation.

 

Pursuant to the settlement agreement, Vanguard agreed to pay slightly more than $1.88 million to the United States and $119,380 to the state of Tennessee, authorities said. The company also will enter into a comprehensive Corporate Integrity Agreement with the U.S. Department of Health and Human Services.

 

“The resolution of these allegations is another example of this office’s commitment to combat healthcare fraud,” Martin said. “When healthcare providers double bill the Medicare and Medicaid programs, we will hold them accountable. Healthcare fraud remains a priority of this office and we will continue to aggressively pursue fraudulent conduct by those in the healthcare industry and ensure that proper safeguards are in place to prevent fraud.”


Tennessee Attorney General Bob Cooper thanked the state and federal agencies involved in the investigation, saying such work is important here “because ultimately, all Tennesseans pay the price” for double billing.

 

“Companies that pile up profits by filing false claims, as alleged in this case, can count on being relentlessly pursued,” added Derrick L. Jackson, special agent in charge of the Atlanta Region for the Office of Inspector General of the Department of Health and Human Services. “Along with our law enforcement partners, we are dedicated to protecting taxpayers and vulnerable recipients of government health programs.”

 

This resolution reflects a federal emphasis on combating healthcare fraud and “another step,” officials said, for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, launched in May 2009 by U.S. Attorney General Eric Holder and U.S. Department of Health and Human Services Secretary Kathleen Sebelius.

 

The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation, and one of the “most powerful tools” in that effort, authorities said, is the False Claims Act – which the Justice Department has used to recover more than $5.9 billion since January 2009 in cases involving fraud against federal healthcare programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are more than $7.5 billion.

 

Miami Home Health Agency Nabbed

 

A patient recruiter for a Miami-based home health agency, one of 21 co-defendants in a case involving a $25 million Medicare fraud scheme, has pleaded guilty to her involvement in the matter, according to a joint announcement by the U.S. Department of Justice, the U.S. Department of Health and Human Services and the FBI.

 

Beatriz Torres-Cruz, 50, pleaded guilty before U.S. District Judge Joan A. Lenard, sitting in Miami, to one count of conspiracy to commit healthcare fraud and one count of solicitation of healthcare kickbacks, authorities said.

 

According to court documents, Torres-Cruz worked for Florida Home Health Providers Inc., an agency that purported to provide home health and physical therapy services to Medicare beneficiaries. Florida Home Health billed the Medicare program for expensive physical therapy and other services that were medically unnecessary and/or never provided, the documents indicated. In many cases those services were prescribed by doctors, including Jose Nunez, who was charged in a February 2011 indictment along with Torres-Cruz and 19 others, authorities said (17 of those co-defendants, including Nunez, since have pleaded guilty).

 

Torres-Cruz admitted that, beginning in approximately January 2006 and continuing until approximately March 2009, she and others offered and paid kickbacks and bribes to Medicare beneficiaries who would agree to allow Florida Home Health to bill Medicare for services that were medically unnecessary and/or never provided, according to the investigation. Torres-Cruz also solicited and received kickbacks and bribes from the owners and operators of Florida Home Health in return for her patient recruiting services, authorities said, adding that Torres-Cruz knew that the patients she recruited for Florida Home Health did not qualify for the services billed to Medicare.

 

As a result of Torres-Cruz’s participation in the scheme, Medicare was billed approximately $195,000 for purported services that were not medically necessary and/or were not rendered at all, according to officials.

 



 

Sentencing has been scheduled for Jan. 30, 2012. The charge of conspiracy to commit healthcare fraud carries a maximum prison sentence of 10 years, and the charge of solicitation of healthcare kickbacks carries a maximum prison sentence of five years. Torres-Cruz also face fines and terms of supervised release, as well as forfeiture of any property or proceeds derived from her criminal activities, authorities said.

 

 

The investigation into the scheme was launched as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Miami.

 

Since their inception in March 2007, Medicare Fraud Strike Force operations in nine locations have charged more than 1,140 defendants who falsely billed the Medicare program for more than $2.9 billion collectively. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with the Department of Health’s Office of Inspector General, is taking steps to increase accountability and decrease the presence of fraudulent providers.

 

To learn more about the federal government’s efforts to fight fraud in healthcare, go online to www.stopmedicarefraud.gov.

 

Mark Spivey is a correspondent for the RACmonitor.com and ICD10monitor.com websites. He can be reached at mcspivey@hotmail.com.

 

To comment on this article please go to editor@racmonitor.com

 

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