Hefty sentences imposed in old fraud case, conviction obtained in new one

The Department of Justice (DOJ) is taking another leap forward in its efforts to stop Medicare fraud. The agency obtained a conviction against a medical supply company owner in California for his role in a $4 million fraud scheme. Simultaneously in Florida, the perpetrators of a $63 million scheme all received hefty prison sentences and are scheduled for a restitution hearing.

A royal scheme

Valery Bogomolny, the owner of Royal Medical Supply, billed Medicare $4 million over the course of three years for medical supplies that beneficiaries did not need, did not receive, or both. The evidence in the case showed that the program was billed for power wheelchairs, back braces, and knee braces and that he personally delivered the wheelchairs to patients who could walk on their own. The owner created documentation falsely showing that home assessments were taken. The government paid Bogolmony $2.7 million for these false claims. There will be a sentencing hearing on February 29, 2016.

Miami HEAT continues to melt fraud scheme

The breakdown of a Miami mental health fraud scheme continues as four more co-defendants were sentenced following their August conviction (Jury hands down convictions in $63M health care fraud scheme, Health Law Daily, August 26, 2015). The former medical director of Health Care Solutions Network, Inc (HCSN) received a sentence of 192 months imprisonment. One of the therapists convicted in August received a 72 month sentence, while the other two were each sentenced to 60 months. A restitution hearing will be held in January. In all, 22 defendants have been convicted in the HCSN scheme.

These sentences followed convictions based on evidence which showed that HCSN billed the government for mental health services that were not medically necessary and often not provided. HCSN frequently altered and fabricated medical records, and paid kickbacks to assisted living facilities in exchange for referrals.

Stopping fraud

These fraudulent schemes were uncovered by the Medicare Fraud Strike Force, which according to the DOJ, has charged nearly 2,300 defendants who have collectively billed the Medicare program for more than $7 billion. The DOJ works with other government agencies to investigate, charge, and convict providers who fraudulently bill the Medicare program. The Health Care Fraud Prevention and Enforcement Action Team (HEAT) is an important part of these efforts. HHS is also committed to increasing accountability among providers.