Getting In On the Action

Whenever easy money is to be had, opportunists usually abound. An article published on EHRIntelligence.com describes a huge Medicare fraud scheme where seven people got in on the action to bilk the benefits program of $97 million. (That’s quite an enormous amount of money to be taken from people who actually qualify and need government assistance.)

The story centers on two physicians and owners of a Houston mental healthcare company, which was supposed to provide partial hospitalization program (PHP) services for the outpatient treatment of patients with severe mental illness. The 81-year-old and 66-year-old owners were assisted by a physician’s assistant and a group home owner who signed admission documents and case notes stating that the patients Medicare was billed for qualified for the PHP services. Court records state Medicare was frequently billed for PHP services, while the patients were actually watching movies, coloring or playing games. (Undoubtedly, these activities are not covered by Medicare.)

The owners and the company administrator also paid kickbacks to multiple group home operators and patient recruiters to deliver ineligible Medicare beneficiaries to the mental healthcare company for services that were not necessary. Further research shows that some of the patients even got in on the action and received a few kickbacks for showing up for mental health services. (Like I said, when there is an opportunity to make a little money without much effort, it’s usually not hard to find willing participants.) The two owners, plus the company administrator, physician’s assistant, patient recruiter and two group home owners were convicted by jury for their part in this enormous scheme to steal money from Medicare. (In hindsight, what seemed like a great opportunity to make some fast cash now appears to be a pretty bad idea to the criminals, who await their fate.)

This case just goes to show that you don’t mess with the Medicare Fraud Strike Force, who brought down this criminal operation that lasted approximately five years. Since 2007, more than 1,700 defendants, who have collectively billed the Medicare program for more than $5.5 billion, have been charged. This case also proves that the government is serious about increasing accountability and decreasing the fraudulent activities of healthcare providers.

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