Medicare Compliance & Reimbursement

Why hiring Medicare and Medicaid beneficiary recruiters or marketers might not be wise.

Submitting alternating pressure mattress claims to Medicare without providing them to beneficiaries could grab the Department of Justice's attention.

Houston durable medical equipment company Transcon Medical Services, Inc. owner Sunny Alfred Imeh pleaded guilty to conspiracy and health care fraud, according to a June 14 DOJ press release. Feds Paid For Unprovided Wheelchairs, Mattresses Between January 2000 and June 2003, Imeh fraudulently billed Medicare and Medicaid for nearly $5 million and defrauded the health care programs of $1.6 million through false DME claims, the DOJ alleges. Imeh purportedly billed Medicare and Medicaid for motorized wheelchairs and alternating pressure mattresses he never provided.

In some cases, he provided less expensive or used scooters and regular mattresses, the DOJ says. Imeh purportedly paid Medicare and Medicaid beneficiary recruiters between $200 and $500 to obtain Medicare and Medicaid beneficiaries' information and instructed the recruiters to take the beneficiaries to certain Houston-area doctors for certificates of medical necessity for DME, the DOJ alleges.

Punishment: Imeh faces five years imprisonment and a $250,000 fine for the conspiracy conviction and 10 years and a $250,000 fine for the health care fraud conviction. A judge will sentence him on Sept. 7, 2005.

To read the press release, go to http://www.usdoj.gov/usao/txs/releases/June2005/050614-Imeh.htm.