August 28, 2012

Three Fraud Cases Result in Jail Time

By

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A trio of health care fraud cases led to multi-year prison terms for three people:

  • In Louisiana, the owner of a durable medical equipment (DME) company was sentenced to 15 years in prison after pleading guilty for his role in several Medicare fraud schemes involving fraudulent claims and illegal kickbacks for unnecessary equipment, the Justice Department stated. Henry Lamont Jones of Prairieville, La., also has to pay almost $13.4 million in restitution jointly and with convicted co-defendants.
  • In Mississippi, a doctor was sentenced to 14 years in prison in connection with charges of health care fraud, wire fraud, making false statements related to health care, theft of government funds and conspiracy to commit health care fraud, according to the U.S. Attorney in southern Mississippi. Cassandra Faye Thomas owned Central Mississippi Physical Medicine Group, which billed $12 million to Medicare and Medicaid for services as if they were provided by doctors or licensed physical therapists. The services were actually provided by employees who were not trained or licensed as therapists. Medicare and Medicaid paid more than $6.9 million on those claims.
  • In Florida, a Miami-area assisted living facility owner was sentenced to two and a half years in prison in connection with charges that he funneled patients to a fraudulent mental health care provider, American Therapeutic Corporation, the Justice Department stated. Bobby Ramnarine also must pay $165,881 in restitution. He agreed to send residents of the assisted living facility, Elmina Inc., to the corporation in exchange for kickbacks. He was responsible for more than $445,025 in fraudulent billing to Medicare.

RAC News

In recovery auditor (RAC) news, just one issue was posted by DCS Healthcare Services, the Region A RAC.

Outpatient hospital

Name of issue

Date posted or approved

Regions/states where it is active

Description of issue

Document sources

Adenosine 30 mg excessive units reported

8/20/12

Conn., D.C., Del., Md., N.J., N.Y., Pa.

Identified overpayment of Adenosine 30 mg when reported with units greater than 10

NGS LCD L26859; Highmark LCD L31187; CMS Pub. 100-08 chapter 3; HHS Health Care Financing Services – HCFA Rulings No. 95-1; CMS-approved pharmaceutical compendium Clinical Pharmacology, Adenosine; CMS-approved pharmaceutical compendium Thomson Micromedex DrugDEX, Adenosine

About the Author

Karen Long is the editor of Physician Solutions 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

Karen Long

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