Kusserow’s Corner: $12 Million Visiting Physician Practice Fraud Scheme Indictment

The federal government has been aggressively investigating home health billing including in-home physician visits and home health agency and other related billings to Medicare. On October 29, 2013, the Department of Justice (DOJ) in Illinois unsealed indictments for Rick E. Brown, along with alleged co-conspirator, Roger A. Lucero and Mary C. Talaga for engaging in a $12 million health care fraud scheme operating out of a home visiting physician practice, Medicall Physicians Group Ltd, that billed for services never provided. The indictment alleges employees were instructed to bill Medicare for patient oversight and other services that were never provided, and backdated records were created in an effort to conceal the fraudulent billings.

This follows another major Illinois case of the same type in August of this year. Dike Ajiri, the chief executive officer of Chicago-based Mobile Doctors, arranged patient home visits and contracted with doctors who perform house calls in six states was charged with health care fraud. The physicians assigned their rights to bill and collect payment to Mobile Doctors in return for being paid directly by the company. Included in the charges at that time was one of its physicians, Dr. Banio Koroma, in Chicago. In addition to arrests, search warrants were executed at Mobile Doctors’ offices in Chicago, Detroit, and Indianapolis, as well as warrants to seize up to $2.568 million in alleged fraud proceeds from various bank accounts. The charges allege a scheme to fraudulently increase (also known as “upcoding”) Medicare bills for in-home patient visits that Mobile Doctors falsely claimed were more complicated and longer than they actually were, exceeding $12 million in Medicare payments. Members of the scheme also falsely certified that patients were confined to their homes, enabling home health care agencies to claim fees for additional services for patients who were not actually qualified to receive them.

Similar cases have been prosecuted around the country.

Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

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Copyright © 2013 Strategic Management Services, LLC. Published with permission.