Medicare Compliance & Reimbursement

Fraud enforcement seeks out all players in lack of medical necessity cases

The long arm of the law tapped a few more shoulders last December.
 
More charges were announced relating to a Los Angeles Medicare fraud scheme that allegedly involved approximately $2.6 million in fraudulent DME claims.
 
The latest indictment alleges that Sumner Bohee, physician and owner of the Los Angeles-based Phoenix Multi-Specialty Clinic received patients referred by the three defendants, Steve Jari, Keith Allison and Bernard Townsend. The defendants allegedly worked as "cappers" for Vasu Deo, a man previously charged with defrauding Medicare for unnecessary or nonexistent medical equipment.
 
Bohee, who had his physician assistant examine the majority of the patients involved with the contested claims, allegedly received illegal kickbacks from Deo and the cappers for signing certificates of medical necessity recommending motorized wheelchairs or hospital beds for beneficiaries. The CMNs were then given to Deo to bill Medicare for the equipment. 
    
In many cases, the Medicare beneficiaries had no medical need for the equipment and never received it. Deo submitted approximately $2.6 million in fraudulent claims, and Medicare paid him approximately $1.15 million.
 
"These arrests should send the message loud and clear that law enforcement is actively investigating not only the crooked durable medical equipment suppliers, but also the marketers, patient recruiters, doctors and others needed to pull off these sorts of schemes," said Acting Principal Deputy Inspector General Dara Corrigan of the Department of Health and Human Services.
 
Bohee is charged with three counts of money laundering - which could bring as much as 20 years in jail - as well as four counts of taking kickbacks.  Bohee and two of the cappers were each charged with nine counts of health care fraud, each count carrying a maximum possible penalty of 10 years in federal prison.

No End In Sight To Enforcement
 
In a similar case, U.S. Attorney Marcos Jimnez announced Dec. 29 that former supplier Todd Neff will be serving a 53 month prison sentence and will pay Medicare $1.7 million in restitution for his part in a multi-million dollar fraud scheme. Neff was also ordered to serve a concurrent 53-month sentence for fleeing to Costa Rica before his trial, as well as 3 years of supervised release.
           
Neff was indicted along with 6 other codefendants, including co-owner Chadd Miller who was previously sentenced to 87 months in prison and also ordered to pay $1.7 million in restitution. Carlos Scott, who worked as a recruiter for Neff and Miller's Miami-area companies, Imagine Consulting and K&F Services, was also slapped with 87 months and a $1.7 million fine.
  
According to the indictment, the companies submitted $5 million in fraudulent claims to Medicare after they hired and paid kickbacks to Medicare beneficiaries who agreed to serve as fictitious power wheelchair recipients at "staged" deliveries.  
           
Lesson Learned: Medical equipment suppliers can expect an aggressive regulatory climate.