Medicare Compliance & Reimbursement

Medicare fraud charges leveled at suppliers in Texas, Pennsylvania.

Operation Wheeler Dealer continues to turn up millions in reportedly fraudulent motorized wheelchair claims.

A Pennsylvania durable medical equipment supplier has forked over more than $335,000 to settle false claims act charges for power wheelchairs, and its former Chief Operating Officer and Compliance Officer faces possible jail time.

Bristol-based Inglis Durable Medical Equipment Company Inc. discovered billing irregularities after a routine billing information request to COO/CO Scott Katherine, an Inglis official told the Philadelphia Inquirer. Inglis fired Katherine and turned over its findings to the feds.

Pennsylvania U.S. Attorney Patrick Meehan in a June 30 filing accused Katherine of a plethora of fraudulent wheelchair billings, including billing for pricier K0014 wheelchairs when K0011 chairs were furnished; billing for accessories such as power tilt and power elevated leg rests when they weren't provided; billing used wheelchairs as new; and fraudulently completing certificates of medical necessity. The billings took place from April 1998 to October 2003.

The fraudulent billings totaled $264,000, Meehan charges. If convicted, Katherine faces a maximum possible prison sentence of 10 years, a $250,000 fine, and a minimum of three years up to a lifetime of supervised release, Meehan says. But Meehan's filing indicates a settlement is likely. Katherine's attorney told the Inquirer Katherine has cooperated with the investigation and is helping the government ferret out similar abuse.

Inglis has agreed to reimburse private insurers and patients for improper billings made by Katherine. And Inglis has entered into a three-year Corporate Integrity Agreement with the HHS Office of Inspector General.

Meanwhile, two executives of a Lufkin, TX-based DME company pleaded guilty to Medicare fraud June 25, according to the office of the U.S. Attorney for the Eastern District of Texas.

All Divine Health Services allegedly submitted more than $4 million in claims for power wheelchairs and accessories that were either not medically necessary or, more often, were not delivered at all.

Becalo Utuk, 44, and Iris Bonilla, 23, cashed in almost $2 million from the scheme, prosecutors allege. "Utuk allegedly diverted the fraud proceeds for her own personal use and benefit," the U.S. Attorney says.