From the DOJ: Ambulance Company Operator in Houston Pleads Guilty to Fraud

A Houston area ambulance service operator plead guilty yesterday to conspiracy to commit healthcare fraud related to over $1.7M in billings for transports connected to “community mental health centers”  If you don’t remember, this case sounds very similar to some cases that I have previously blogged about and warned ambulance companies that if the net had not already tightened, it would be doing so soon.

Of note in this case is the amount of restitution versus the amount of billing claimed.  Mr. Ofoegbu agreed to a little over $500K in restitution for allegedly fraudulent billings of more than three times that amount.  However, if you are at all familiar with how billing in the EMS (and medical world in general) world operates, you would not find this surprising because it is likely that the $500K amount was the actual amount paid by Medicare while the $1.7M was the amount billed to Medicare. This is a typical discrepancy in these case and underscores the underlying problems with healthcare and with Medicare reimbursements.

The text of the DOJ press release is reprinted after the jump.

Marc

Department of Justice

Office of Public Affairs
FOR IMMEDIATE RELEASE
Monday, October 15, 2012
Houston Ambulance Company Administrator Pleads Guilty to Fraud

WASHINGTON – The administrator of CardioMax EMS, a Houston-based ambulance company, pleaded guilty today to charges that he submitted approximately $1,734,550 in fraudulent claims to Medicare, announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Kenneth Magidson of the Southern District of Texas; Special Agent-In-Charge Elvis McBride of the FBI’s Houston Field Office; Special Agent-in-Charge Mike Fields of the Dallas Regional Office of the U.S. Department of Health and Human Service’s Office of the Inspector General (HHS-OIG); and the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU).

Okechukwu Ofoegbu, 31, of Houston, pleaded guilty today in U.S. District Court in the Southern District of Texas to one count of conspiracy to commit health care fraud.

Ofoegbu was the administrator of Cardiomax EMS, a Houston-based ambulance company that primarily transported patients to community mental health centers.  According to Ofoegbu’s plea agreement, from January 2011 through December 2011, Ofoegbu and others at Cardiomax were involved in transporting patients that did not meet the requirements for ambulance transport under Medicare regulations, falsifying ambulance run sheets that described patients’ conditions and using the falsified run sheets to file claims with Medicare.  Ofoegbu admitted in his plea agreement that he conspired to submit claims to Medicare for ambulance services that he knew were miscoded, not medically necessary and, in some cases, not provided.

As part of the plea agreement, Ofoegbu has agreed to pay $553,002 in restitution to the United States.  At sentencing, scheduled for Jan. 24, 2013, Ofoegbu faces a maximum sentence of 10 years in prison.

Ofoegbu was originally indicted as part of a nationwide takedown on May 2, 2012, that resulted in charges against 107 individuals, including doctors, nurses and other licensed medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $452 million in false billing.

The case was prosecuted by Trial Attorney Laura M.K. Cordova, Special Trial Attorney James S. Seaman, Special Trial Attorney Ronald Cummings and Deputy Chief Sam S. Sheldon of the Criminal Division’s Fraud Section.  The case was investigated by HHS-OIG, FBI and the Texas Attorney General’s Medicaid Fraud Control Unit, as part the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Southern District of Texas and the Criminal Division’s Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.

12-1242
Criminal Division

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