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Unlicensed Michigan Physician Pleads Guilty to Conspiracy to Commit Wire Fraud for Role in $6.3 Million Detroit-Based Medicare Fraud Scheme

A Michigan man pleaded guilty to fraud charges for his role in a scheme to defraud Medicare out of approximately $6.3 million while he acted as an unlicensed physician at a Detroit in-home physician services company. Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Barbara L. McQuade of the…

South Miami Hospital Agrees to Pay the United States $12 Million to Settle False Claims Act Allegations

According to the United States Department of Justice, U.S. Attorney’s Office in the Southern District of Florida, South Miami Hospital, a not-for-profit regional hospital located in South Miami, Florida has agreed to pay the United States approximately $12 million to settle allegations that it violated the False Claims Act by submitting false claims to federal…

Virginia Personal Health Care Scam Denies Disabled Boy Needed Care

Three people are indicted for health care fraud when they were found having defrauded Medicaid for more than $350,000. The grand jury indicted Deborah Branch, 64, Melissa Harr, 49 and Bryan Harr, 40 of health care fraud, conspiracy to commit healthcare fraud and two counts of wire fraud. Prosecutors say that Branch was employed by a…

North Carolina to Reimburse the Federal Government $15+ Million for Improper Claims

According to the OIG Report, https://oig.hhs.gov/oas/reports/region4/41504037.asp, “The North Carolina Department of Health and Human Services (State agency) claimed Federal Medicaid reimbursement for some nonemergency medical transportation (NEMT) services that did not comply with Federal or State requirements. Of the 200 sample items, 82 complied with Federal and State requirements, but 118 did not. Of the 118…

Medicare/Medicaid Fraud Lands Chimaroke Echenwune a 30-Year Prison Sentence

In the worst style of committing Medicare/Medicaid fraud, Houston, TX-based Chimaroke Schenwune, who ran an ambulance company, Diamex EMS, with his wife scammed mentally handicapped patients by transporting them to daycare facilities instead of hospitals. Transport to daycare facilities is not covered by Medicare or Medicaid, but transport to hospitals is. The result is more…

Medicaid Fraud Losses Exceed Recovery by Millions in North Carolina

Medicaid fraud is at a crisis level of losses that exceed recovery in North Carolina. The Final Report to the Joint legislative Program Evaluation Oversight Committee, Report Number 2016-10 dated November 14, 2016, entitled: “Medicaid Program Integrity Section is Not Cost-Effectively Identifying and Preventing Fraud, Waste, and Abuse, reveals that costs to discover fraudulent claims…

HHS and OIG Release Fiscal Year 2017 Work Plan – Highlights

The U.S. Department of Health and Human Services (HHS), Office of Inspector General (OIG), fiscal year 2017 Work Plan gives an overview of new initiatives and activities as well as reports on ongoing programs. According to a HMENEWS, the recently released work plan includes the OIG’s plans to review, “the process CMS used to conduct…

Medicare Fraud Strike Force Successful with “Big Data” Detection Methods.

In a story reported by The Fiscal Times, U.S. customs officials arrested a woman at the Dallas-Fort Worth International Airport mid October, 2016, who is suspected of involvement in one of the biggest Medicare fraud schemes in history. This bust is another record-breaking fraud scheme that found its end as part of the Obama administration’s crackdown on Medicare…

New York Doctor Convicted of Multimillion-Dollar Health Care Fraud

A New York surgeon who practiced at hospitals in Brooklyn and Long Island, New York, was convicted last night for submitting millions of dollars in false and fraudulent claims to Medicare. Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Robert L. Capers of the Eastern District of New York,…

The Power of Work Teams

Part 5 of 6 – Tips from Craig’s Verification Tips on Staffing for The Art and Science of Verifications Distributed Leadership Provides Mentoring and Motivation If your verification department has more than 10 people, you should consider using work teams of 5 to 6 people each for these reasons: 1. Competition between teams makes the…