Medicare Compliance & Reimbursement

Bonus:  Federal appeals court rejects 'no harm, no foul' argument regarding false Medicare claims.

Three medical supply company owners from Miami, FL, were arrested in connection with two alleged schemes that billed Medicaid some $183,000 for equipment that was either not prescribed or not received by patients, Florida Attorney General Charlie Crist announced Sept. 7.

Charged in Miami-Dade County Circuit Court with organized fraud and grand theft were Arnaldo Iglesias, former owner of I. Cowan Medical Equipment and Supply Corp., and Jorge Fernandez-Romero and Alain Fernandez, former owners of JC Medequip & Supplies Inc., said Crist in a written statement.

Iglesias allegedly billed Medicaid $121,000 for colostomy and catheter supplies that were not prescribed by providers whose names appeared in the billings, according to a statement by Crist.

Fernandez-Romero and Fernandez allegedly billed Medicaid nearly $62,000 for prosthetic devices that were not provided, the statement added.

In other fraud news, a lower court erred in determining a health care consultant and two home health agencies caused no loss to Medicare because no crime was committed, a federal appeals court said Sept. 5.

The U.S. Court of Appeals for the Eleventh Circuit held that Medicare's willingness to pay up to its cost caps did not absolve Mahendra Pratap Gupta from his violation of the related party regulations or from his liability for submitting false claims to Medicare. The amount the government paid in response to the false claims was an appropriate measure of damages, the appeals court concluded.

"The court's belief that no crime was committed does not nullify its duty to calculate the [U.S. Sentencing] Guidelines loss amount. Moreover, the purpose of the related party rule is to prevent the payment of artificially inflated consulting fees," said Judge Eugene E. Siler Jr. of the U.S. Court of Appeals for the Sixth Circuit. "The 'no harm, no foul' argument culminating in a calculation of no loss to the government has been regarded as an insufficient rationale by which to calculate loss," he added.

Text of the court's decision is available online at www.ca11.uscourts.gov/opinions/ops/200416091.pdf.