Home Health & Hospice Week
Fraud Crackdown On Suppliers Sweeps Across Nation
Wheelchair fraud enforcement actions continue to rack up.
Prosecutors are revealing the bones of a massive fraud scheme based in Harris County, TX - the epicenter of Operation Wheeler Dealer enforcement.
A 68-count indictment against two Houston-area physicians and two durable medical equipment companies has been unsealed, says Texas U.S. Attorney Michael Shelby. The charges, including health care fraud, money laundering, wire fraud and conspiracy, accuse the defendants of bilking Medicare of a staggering $40 million in a mere 17 months.
According to prosecutors, the scheme worked like this: 1st Choice Medical Equipment and Supply owner Harold Horatio Iyalla and Horizon Medical Supply owner Pius James Ekiko paid kickbacks to recruiters who enlisted "thousands of Medicare beneficiaries" in the wheelchair scam. Recruiters transported the beneficiaries to be seen by physicians Charles Frank Skripka, Jr. and Jayshree Patel.
Dr. Lewis Gottlieb, who has already pled guilty in the scheme, hired Skripka and Patel at his clinic "solely to authorize motorized wheelchairs for Medicare beneficiaries who clearly did not meet the Medicare guidelines to receive such a device," Shelby charges. From February 2002 to June 2003, the physicians "routinely approved wheelchairs for as many as thirty to fifty patients a day using a written script given to them by Dr. Gottlieb."
The suppliers paid the physicians a kickback for each false certificate of medical necessity, prosecutors charge, and delivered a scooter instead of a more expensive wheelchair to the beneficiary. The physicians also allegedly billed Medicare for unnecessary office visits and medical services.
"DME fraud is a major and increasingly serious problem," Federal Bureau of Investigations Special Agent in Charge Tim Menke says in the release. The FBI, the Department of Health and Human Services and the HHS Office of Inspector General cooperated in the investigation.
This spring, authorities froze $1.25 million in a bank account for Ekiko and Horizon, and $758,000 in an account for Iyalla and 1st Choice. The government is seeking $21 million in forfeitures from the three physicians and two suppliers. Gottlieb already has forfeited $1.6 million (see Eli's HCW, Vol. XIII, No. 14, p. 106).
The maximum penalties for the charges are decades of jail time and hundreds of thousands of dollars in fines. The indictment remains under seal because more defendants are slated for arrest under the charges, Shelby says.
In other fraud enforcement news:
Prosecutors also accused Close of billing for expensive accessories like $300 pressure-reducing gel positioning cushions, when patients got only cheap foam cushions. And he was convicted of trying to alter the delivery slips for the equipment and laundering proceeds from the scheme by promoting the business and building a home in Rathdrum, ID, reports The (Twin Falls, ID) Times-News.
The scheme came to authorities' attention when sharp-eyed Medicare beneficiaries reported billing discrepancies in 2001, Wendy Olson, the assistant U.S. Attorney who prosecuted the case, told the Spokesman-Review. "Durable medical equipment is an area ... that's rife with fraud," Olson says. But this is the only wheelchair fraud case authorities have turned up in Idaho.
Close sought numerous delays to the trial, and some charges had to be dropped because elderly witnesses died, got too ill to testify or couldn't be located, the paper says. Close sold Back 'N Action to Soper's Mobility Aids in 2001.
Close faces maximum penalties of 10 years in prison and $250,000 in fines on each fraud charge, 20 years and $500,000 in fines on each of the money laundering charges and five years and $250,000 in fines on each obstruction of justice charge, the Times-News notes. A sentencing date has not yet been set.
According to Kentucky Attorney General Greg Stumbo, from 2000 through 2002 Jeramey Etherton allegedly falsified documents while attempting to represent doctors' orders for power wheelchairs. "No doctors had authorized the chairs," Stumbo's office said in a July 20 release.
Through his company, known as both Wheelpower Inc. and Heartland Medical, Etherton would get paid for wheelchairs he never delivered, Stumbo says.
Prosecutors have charged Lazaro Betancourt, Carlos Marx Mesa, Kenia Mesa, Osvaldo Piedra, Viridiana Negrin, Gilberto Herrera, and Guillermo Carnet with health care fraud and allegedly laundering $4 million of $7 million they stole from Medicare through bogus DME supply companies.
The suppliers reportedly billed Medicare for services and products that they didn't furnish or that were medically unnecessary.
Jimnez says the government could seek as much as $14 million in restitution.
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