The United States Department of Justice today unveiled charges against a total of 91 individuals in 7 different locations for allegedly fraudulent activities that allegedly cost Federal healthcare programs in excess of 535 million dollars. The highlights for EMS providers and Texas:
- Alpha Ambulance Inc. (Los Angeles, CA): Approximately $49.2 million in fraudulent billing for ambulance transportation that was allegedly medically unnecessary. This represents the largest ambulance fraud scheme prosecuted by the Medicare Fraud Strike Force;
- In Dallas, 14 individuals – including two doctors and two registered nurses – were charged for their alleged participation in various fraud schemes involving a total of $103.3 million in false billings. In one case a medical doctor and two registered nurses were charged with participating in a fraud scheme which led to approximately $100 million in fraudulent billing for home health care services. According to court documents, the doctor signed approximately 33,000 prescriptions, allegedly without even reviewing them, for more than 2,000 unique Medicare beneficiaries from 2006 to 2011, many of whom had primary care physicians who never certified home healthcare services for them;
- Seven individuals were charged in Houston for alleged participation in a fraud scheme which led to $158 million in fraudulent billing for mental health services. According to court documents, the defendants allegedly paid kickbacks in the form of cigarettes, food and coupons redeemable in the hospital’s “country stores” to Medicare beneficiaries in exchange for those beneficiaries’ attendance at the hospital’s partial hospitalization programs (PHP). The assistant administrator of the hospital, Mohammad Kahn, plead guilty to conspiracy to commit health care fraud and paying kickbacks on Feb. 22, 2012.
I always love the last little tidbit that the DOJ adds to these press releases: “The charges and allegations contained in the indictments are merely accusations and the defendants are presumed innocent unless and until proven guilty.”