Kusserow’s Corner: Former Veterans Affairs Psychiatrist Guilty of Home Health Fraud

In the last couple of months, I have reported on how home health fraud and abuse cases continues to be a priority of the DOJ, OIG, CMS, and State Medicaid agencies. Home health programs are intended to provide an alternative to institutional care for people with severe disabilities and it is intended that the needed services be delivered in a beneficiary’s home. Unfortunately, these programs are susceptible for exploitation by unscrupulous individuals who believe that personal care services are an easy target for fraud. Examples of various types of fraud cases have been reported in recent blog articles.

The latest enforcement action provides a new twist to fraud and abuse in home health. Dr. Mikhail L. Presman, a licensed psychiatrist a full time employee at the Department of Veterans Affairs (VA), pleaded guilty to Medicare fraud for falsely billing for home medical treatment. He agreed to forfeit more than $1.2 million in illegal profits. He had been arrested on May 15, 2013. Over a period of seven years, he submitted approximately $4 million in Medicare claims for home treatment of Medicare beneficiaries, while being a full-time, salaried position as a psychiatrist at the VA hospital in Brooklyn, NY. He further did not provide any treatment to a substantial number of the beneficiaries he claimed to have treated. Many of the claims submitted to Medicare for home medical visits at locations within New York City were made while he was physically located in China. He also submitted claims to Medicare for 55 home medical visits to beneficiaries who were hospitalized on the date of the purported visits. Presman is scheduled to be sentenced in New York on Feb. 13, 2014. He faces $3.6 million in fines and up to 10 years in prison following his guilty plea.

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.