Medicare Compliance & Reimbursement

Home health, opioid fraud are top DOJ targets.

 Federal enforcement agencies got right down to business once the government shutdown ended. Moreover, the first week of enforcement shows that the feds intend to hold physicians accountable for fraud schemes in 2019.

In Texas: Two separate cases in Houston spotlight home health fraud. Physicians, John P. Ramirez, MD, and Anh Do, MD, were condemned to long prison terms and millions in restitution for their attempts to defraud Medicare.

Judgment day: Between December 2011 and August 2015, Dr. Ramirez in coordination with Amex Medical Clinic owner, Ann Shepherd, and co-conspirator, Yvette Nwoko, operated a plan to defraud Medicare, suggested a Department of Justice (DOJ) release. Ramirez falsified medical orders that suggested a need for medical services for patients and then sold the information to Shepherd and Nwoko. The medically unnecessary services were never provided and amounted to millions in fraudulent Medicare claims.

For his part, Ramirez was sentenced to 25 years in prison, plus an add-on of another three years of supervised release. In addition to the significant punishment, the physician is also required to pay back more than $26 million in restitution for his crimes against Medicare, the DOJ release said. Shepherd will spend 30 years behind bars and fork over $20 million for her contribution to the scheme; Nwoko awaits sentencing.

Fines for fraud: Dr. Do received more than $10 million in Medicare payment for false claims and “admitted to fraudulently signing Plans of Care and other medical documents that falsely and fraudulently certified and recertified patients for home-health services,” noted the DOJ. In addition, Do was paid another $2 million for submitting claims for diagnostic tests that were both medically unnecessary and never performed. His sentencing includes a three-year prison term, three years of supervision on release, and $1.875 million payback and hundreds of thousands in forfeited Medicare payments, DOJ indicated.

Read more about these two cases and sentencings at www.justice.gov/opa/pr/two-south-texas-doctors-sentenced-prison-roles-separate-multi-million-dollar-medicare-fraud.

In Florida: Forced to rescind her Florida medical license, Jayam Krishna Iyer was permanently excluded from Medicare and other federal healthcare programs for a combination of false billings and illegal opioid prescribing. Iyer falsely billed “for face-to-face office visits with Medicare and Medicaid patients, when, in fact, certain patients had not gone to” her practice, nor “been examined by her on the claimed dates,” a DOJ release stated.

EHR debacle: During the time when she said she was attending patients, Iyer was instead handing out Schedule II controlled-substance prescriptions in the absent patients’ names to their families, explained the DOJ. The Clearwater, Florida-based provider then doctored her EHRs by uploading false vitals and notes to make it look like she’d administered care.

For her scheme and in addition to losing her right to practice medicine, Iyer was sentenced to six months in prison and the forfeiture of $52,000 in Medicare payments.

See the logistics of Iyer’s case at www.justice.gov/usao-mdfl/pr/clearwater-doctor-sentenced-prison-health-care-fraud.

In Georgia: While awaiting a flight to Colombia on Christmas eve, Johnny Di Blasi, MD was taken into custody by the feds in Miami for illegally prescribing a myriad of Schedule II and IV controlled substances. Di Blasi, nicknamed “Dr. Johnny,” is charged for writing prescriptions to “non-patients” for opioids and amphetamines through his two clinics in Georgia, across 11 states, and to random people he met in bars and restaurants, the DOJ said. He also tried to conceal the fact that he’d written the prescriptions without any medical reasoning, according to the agency.

Feds weigh in: “A key component of the opioid crisis gripping our nation is the supply chain provided by unscrupulous, profiteering medical professionals who violate the law while breaking their oath to ‘do no harm,’” warned Bobby L. Christine, U.S. Attorney for the Southern District of Georgia in a DOJ release. “Even during the holidays, however, our law enforcement agencies and prosecutors will work to remove dangerous drug distributors from our communities, whether they are street-corner dealers or professionals in lab coats.”

See the details of Dr. Johnny’s case at www.justice.gov/usao-sdga/pr/doctor-charged-prescribing-narcotics-non-patients-ordered-detained-until-trial.