Federal officials arrested four people in Texas following an investigation into possible Medicare fraud. Two of the defendants co-own an agency that provides home-health services to patients who qualify for various treatments. Investigators believe that the health care fraud involved providing home-health services to patients who did not actually qualify for them.
As part of the alleged scheme to defraud Medicare, the owners supposedly shared a portion of profits with doctors who were willing to authorize unnecessary in-home services. The agency would then bill Medicare for these unnecessary services. In some cases, they are believed to have filed bills for services that may never have been provided.
The 51-year-old director of nursing at the agency is believed to have played a central role in the alleged fraudulent activities. According to investigators, she began to falsify or alter patients’ medical records as far back as Feb. 2006. The sum amount paid by Medicare based on possible falsified records, unnecessary services and alleged dishonest doctor recommendations is estimated to be at $13 million.
Referrals for additional services might not be as black and white as most people might assume. Patients are often encouraged to seek out second opinions when one doctor or health care provider does not appear to take their concerns seriously, and different doctors might subscribe to different treatment methods that all fall within the lines of the accepted standard of care. Still, the agency owners and two Texas doctors accused of accepting money for creating referrals face potentially serious consequences if a conviction is rendered. It is up to the defendants to ensure that they are as prepared as possible to face their health care fraud charges, which typically includes a careful review of the allegations alongside their respective counsel.
Source: Examiner, “Home-health director of nursing and others arrested for $13 million fraud“, Jack Dennis, Nov. 11, 2015