Medicare Compliance & Reimbursement

Even friends and family can get pulled in by enforcement. As the feds delve more deeply into fraudulent behavior in healthcare, their reach goes beyond the usual suspects. Though owners and physicians continue to receive the toughest settlements, practice managers and support staff are being penalized for their parts as well.

Here are two recent enforcement actions that highlight that trend:

1. Medicare/Medicaid fraud and drug scheme: On Sept. 14, the Department of Justice (DOJ) sentenced a Pittsburgh, Pennsylvania-based physician’s girlfriend with 63 months in prison for Medicare fraud, money laundering, stealing public funds, and illegally distributing oxycodone. In addition to the jail time, Marcia Ramsier Arthurs, will have to pay more than $48,000 in restitution for Social Security fraud and forfeit $1.2 million in personal assets garnered from the healthcare schemes, indicates a DOJ brief.

From 2015 to 2018, Arthurs traveled back and forth from California to Pennsylvania operating a pill mill with her boyfriend and ex-doctor, Paul Michael Hoover. She assisted Hoover with a variety of things from writing prescriptions for cash to mailing illegitimate prescriptions.

With Hoover, Arthurs committed “healthcare fraud by signing preauthorization forms and submitting the forms to Medicare and Medicaid health plans, which then paid for the cost of the illegitimate prescriptions. Hoover and Arthurs also conspired to launder the proceeds from their drug distribution operation,” a DOJ report says.

2. Genetic testing kickbacks: Lake Ariel, Pennsylvania medical assistant Amber Harris pled guilty to conspiracy charges under the Anti-Kickback Statutes (AKS) in a genetic testing bribe scam. From 2018, Harris’ boss, Dr. Yitzachok “Barry” Kurtzer, and his wife, Robin Kurtzer, collected DNA samples from Medicare patients for kickbacks and bribes, sending them to labs in New Jersey and Pennsylvania for genetic testing, charges the DOJ.

The Kurtzers, Harris, and others didn’t let COVID-19 interfere with the fraud either. During the pandemic, “they went from receiving hand-delivered cash kickbacks and bribes to accepting payments by wire and through a cell phone money transfer app,” a report says.