DME Supplier Sentenced to 13 Years in Jail and Dr. Pleads Guilty to Overbilling

A California woman was sentenced to 13 years in prison on March 28, 2013 for her participation in a Medicare fraud scheme involving durable medical equipment, according to the United States Attorney’s Office from the Central District of California. On the same day, the highest billing physician in New Jersey for home care pleaded guilty to one count of health care fraud for billing Medicare for longer face-to-face visits with Medicare beneficiaries than she provided, according to the Newark Division of the Federal Bureau of Investigations.

California DME

Uben Ogbus Rush of Carson California admitted during trial that she submitted more that $15 million in fraudulent Medicare claims for motorized wheelchairs, hospital beds, air pressure mattresses and other items for patients who did not need the equipment. Rush owned and controlled six companies located in Carson, Gardena, Torrance and Paramount, California, according to the United States Attorney’s Office for the Central District of California.

Rush ran the scheme from 1999 to 2008. She paid marketers to recruit Medicare beneficiaries who would allow their identities and Medicare numbers to be used for the submission of false claims. Rush paid kickbacks to marketers, who in turn paid kickbacks to doctors who fraudulently wrote prescriptions, even though the physicians never saw the patients or conducted an examination. Co-defendant Carlos Alberto Rezabala was sentenced to 41 months in prison for his recruiting activities. Another recruiter, Phitsamay Syvoravong is scheduled to be sentenced on May 20th and Dr. Alfred Glover, who testified to providing fraudulent prescriptions, is due to be sentenced on May 28th.

New Jersey Physician Visits

In New Jersey Dr. Lori Reaves, a physician who was the owner and founder of Visiting Physicians of South Jersey, pleaded guilty to charging Medicare for face-to-face visits that were not as long as for which she billed. According to documents filed in the case and statements made in court, Dr. Reaves routinely billed Medicare using codes that would have required her to spend between 60 and 150 minutes with a patient. Some claims would have required Dr. Reaves to spend up to two and a half hours of face-to-face time with clients of Visiting Physicians of South Jersey. Medicare reimbursed Reaves more than $511,068 for the fraudulently provided services.

From January 1, 2008, to October 14, 2011, Reaves was the highest-billing home care provider among more than 24,000 doctors in New Jersey. “The Medicare system depends on doctors and other medical professionals truthfully billing for services they actually provide,” said U.S. Attorney Paul J. Fishman. “Here Dr. Reaves chose to lie about the major services she was providing to her homebound, elderly patients,” he said.