Medicare Compliance & Reimbursement

Fraud is fraud, no matter how old you are. That's what 88-year-old audiologist Adam John Sortini discovered when he was sentenced Dec. 11, 2009 to six months in prison to be followed by 15 months of home confinement, plus restitution of $100,000 for defrauding the Medicare program from January 1998 to January 2003, when the FBI finally raided his office in Merced, CA. Sortini visited skilled nursing facilities across Northern California and billed for hearing tests that were not reimbursable by Medicare because they were routine in nature and were performed without a referring physician's order, according to a press release from the United Stated Department of Justice

(http://www.justice.gov/usao/cae/press_releases/docs/2009/12-14-09SortiniSentencing.pdf ). Also, he did not perform all the tests for which he billed Medicare and supplied forged physician referrals when asked during audits to explain his Medicare claims, the release indicates.

But then he started to slip up. Sortini started billing Medicare for unwarranted hearing tests, including tests for patients with severe mental deterioration and advanced memory impairment. He claimed on certain days to have tested between 25 and 50 or more patients at skilled nursing facilities located more than 100 miles apart, release further states. For these services, he billed and was paid hundreds of thousands of dollars.

During the sentencing, United States Attorney, Benjamin B. Wagner, found Sortini guilty of committing perjury during trial, abusing the trust of the Medicare program, and taking advantage of vulnerable, elderly victims, many of whom were mentally incompetent, according to the release. Keeping all this in mind and after taking into account his age and medical condition, the Judge then passed the sentence.

Another fraud incident was unearthed when B. Bennie Perkins pleaded guilty on Dec 15, 2009, to charges that he'd charged Medicare for $74,000 fraudulently for Personal Care Assistant (PCA) services that were never rendered in the home healthcare company that he owned. In the scam, that continued from from Jan. 6, 2007, to Feb. 28, 2008, Perkins continued submitting false claims to the

Editor's note: The complete Sortini story is posted on the page: http://stopmedicarefraud.gov/innews/california.html#Dec-20-2009; and for details of the Perkins case, visit: http://stopmedicarefraud.gov/innews/minnesota.html. Read the press release of the Sortini case at: http://www.justice.gov/usao/cae/press_releases/docs/2009/12-14-09SortiniSentencing.pdf, and the press release of the Perkins case at: http://www.justice.gov/usao/mn/econ/econ0371.pdf.