Medicare Compliance & Reimbursement
Feds Ratchet Up Enforcement on COVID Fraudsters
Tip: Keep track of your Provider Relief Funds and CAAPs. Over the last year, the neverending stream of COVID-19-inspired regulatory rollbacks and provider funding programs have caused mass confusion across the board. Some have used that uncertainty to their advantage to game the system — but the feds are already on it. From COVID-19 relief fraud to testing scams, check out the latest pandemic-related enforcement. Colorado: If you were wondering whether the HHS Office of Inspector General (OIG) truly investigates what you do with your Provider Relief Fund (PRF) payments, this case is for you. A recently unsealed case alleges that Denver-based physician Francis F. Joseph stole almost $300,000 from three separate COVID-19 relief fund programs at the medical clinic where he practiced, a Department of Justice (DOJ) release suggests. Details: First, Joseph purportedly transferred a combination of PRF payments and COVID-19 accelerated and advance payments (CAAP) from Medicare into his personal account, using the monies for travel, home improvements, and more. Next, after being terminated from the clinic, he “applied for a $179,999 loan under the Paycheck Protection Program (PPP) on behalf of the medical practice, which he then directed into his personal bank account,” the DOJ release says. Additionally, Joseph lied about his termination and subsequent bankruptcy proceedings to pocket the PPP funds. The feds aren’t pulling any punches on this case, considering that the maximum penalties for conviction could bring “10 years in prison for each theft count, 20 years for wire fraud, and five years for the bankruptcy proceeding false statement,” mentions the DOJ release. The court proceedings start on May 25. Missouri: Christian County state representative and licensed physician assistant Patricia Ashton Derges is charged in a complex fraudulent COVID-19 testing scheme that resulted in a 23-count indictment. Derges applied for and received CARES Act funding for the Ozark Valley Medical Clinic, a for-profit with three locations she operates, according to a DOJ release. Then she requested additional CARES Act money for a COVID testing sham at the non-profit Lift Up Someone Today, Inc. that she ran in Springfield. “In total, Derges applied for $882,644 from the CARES Act Relief Fund on Lift Up’s behalf,” a DOJ release says. Here’s the problem: In her CARES Act application, Derges indicated that she’d performed 3,000 COVID-19 lab tests at Lift Up and submitted invoices for the work. In actuality, the tests had been performed at the for-profit, Ozark Family Medical Clinic. The issue is that Lift Up and Ozark are totally separate legal entities, the DOJ brief says. Plus, patients had already paid for the COVID tests at Ozark at upwards of $517,000. The for-profit organization “charged clients, patients, or their patient’s employer approximately $167 per sample for its COVID-19 testing services. Derges allegedly concealed from Greene County that these COVID-19 tests had already been paid for by other payors” on her application, notes DOJ. Michigan: Home health agency (HHA) owner Amina Abbas, of the now defunct HHA 1 on 1 Home Health, was indicted on “the first criminal charges for the intentional misuse of funds intended to provide relief to health care providers and maintain the access to medical care during the pandemic,” the DOJ says in a release. In 2020, Abbas closed 1 on 1 Home Health after Medicare issued an overpayment demand for $1.6 million because the HHA had submitted claims for patients who did not qualify for home health services, the DOJ says. “According to the indictment, 1 on 1, which was never operational during the pandemic, received approximately $37,656.95 designated for the medical treatment and care of COVID-19 patients. Abbas then allegedly misappropriated the funds by issuing checks to her family members for personal use,” according to the DOJ.
Medicare Compliance & Reimbursement
- Fraud & Abuse:
Feds Ratchet Up Enforcement on COVID Fraudsters
Tip: Keep track of your Provider Relief Funds and CAAPs. Over the last year, the [...] - Reimbursement:
Know the Pros and Cons on COVID Financial Relief
Stay on top of PPP deadlines and accelerated payment bill due dates. If the fallout [...] - E/M Coding:
Master Observation Coding Mayhem With These Tips
Study Medicare minutiae on 8-hour stays. Medicare providers have had a lot to unpack over [...] - Clip And Save:
Pocket This Handy HIPAA Security Rule Primer
Tip: Keep staff in the loop on HIPAA security. During the pandemic, there’s been an [...] - Industry Notes:
HHS Revises Provider Relief Guidance … Again
Before you make any big decisions on your Provider Relief Fund (PRF) reporting, you may [...] - Industry Notes:
CMS Puts CHART ACO Transformation Model on Hold Until 2022
Rural providers now have another year to decide if joining a CHART Model Accountable Care [...] - Industry Notes:
HRSA-Funded Health Centers Get Another Boost
In another move to help rural and underserved communities get vaccinated, the feds are inviting [...]
