Madicaid Fraud happens in many different ways. Providers will issue fake invoices or charge the government for services that patients have never received. The following are some of the mor common schemes:
Operation Home Alone: The Attorney General's Operation Home Alone investigation of corruption in the home care industry during 2009 resulted in civil settlements with licensed home health care services and certified home health care agencies totaling $51.7 million and 25 criminal convictions. As part of this ongoing investigation, MFCU indicted two home health aide training schools and their owners for selling phony home health aide certificates - resulting in millions of dollars of unlawful Medicaid billings. In addition, a home care agency and its owner were convicted of stealing more than $1 million for nursing services provided by unlicensed nurses in the State of New York. To date, 125 defendants have been charged and approximately 100 have been convicted through Operation Home Alone.
Pharmaceutical Settlements: MFCU participated in settlements with several pharmaceutical companies, including Eli Lilly, Pfizer, Mylan Pharmaceuticals, Astra Zeneca, and Aventis for off-label marketing, kickbacks, misreporting prices, and other fraud.
Drug Diversion and Prescription Fraud: In 2009, MFCU secured a 3 year prison sentence for a doctor who was convicted of selling prescriptions, which were then filled, and sold on the street - all paid for with Medicaid money. In addition, a pharmacist was sentenced to one year in jail for billing Medicaid over $1 million dollars for prescription drugs that were never dispensed.
Program Fraud: An upstate hospital debt collecting company and its owner were indicted for scamming Medicaid for over $700,000 by bribing a local Department of Social Services employee to assist in approving Medicaid coverage for certain hospital patients. The DSS employee pleaded guilty and is cooperating in the ongoing prosecution. MFCU filed a civil suit against the debt collecting company seeking over $2 million dollars in civil damages and penalties under the False Claims Act and Social Services Law.
Nursing Homes: MFCU filed criminal charges and a civil lawsuit seeking damages of $5 million against a nursing home and its owner for paying kickbacks to a hospital employee for patient referrals ultimately billed to Medicaid. By law, patients are entitled to a choice of 5 nursing homes, but the hospital employee referred the patients to nursing homes he knew would refuse the referral, leaving the patients no choice but to go to the corrupt home. As a result of this scheme, patients were denied a real choice of where they or their loved ones would be admitted.
Dentists: A judge issued a $15.6 million judgment against two dentists who operated a mobile dentist business and who knowingly employed an individual with a prior felony conviction. The convicted felon had also been barred from participating in the Medicaid program and paid kickbacks for Medicaid patient referrals. The felon made illegal payments to have "runners" and "hustlers" refer Medicaid patients to the buses for treatments billed to Medicaid.
If you know of someone commiting Medicaid Fraud, contact The Law Offices of Michael S. Discioarro, LLC at 917-519-8417.
