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HHS-OIG Scrutinizing Billing Practices in West Tennessee
 

Earlier this year, Bill Root knocked on the front door of the home of yet another Medicare beneficiary in the South who had been prescribed an expensive electric wheelchair. After flashing his credentials, Root was invited inside, where he eyed a year-old, unused wheelchair sitting in a corner of the living room with a potted plant in the seat.

Root shook his head. As suspected, the Medicare beneficiary hadn’t ordered the wheelchair, didn’t need it, and when it arrived simply found a place to store it.

For more information on the DOJ/DHHS Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative that includes Medicare Fraud Strike Force teams, visit stopmedicarefraud.gov.

Root, who has worked healthcare fraud cases since 1981, recognized the prescribed wheelchair as part of a durable medical equipment (DME) scheme the U.S. Department of Health and Human Services (HHS)-Office of the Inspector General (OIG) was investigating in Baton Rouge, La. Data-driven information had alerted the OIG of uncommonly high DME activity in the area.

“It’s really disheartening to visit these beneficiaries who were completely in the dark and had no idea that Medicare had paid $6,000 for something that someone else who didn’t qualify might actually need,” said Root, assistant special agent in charge (ASAIC) of Louisiana and Arkansas for the HHS-OIG regional office in Dallas. “Add to that, some doctors were getting referral fees of $500 per script for an unnecessary wheelchair. Some were writing 200 scripts a year. That’s sad.”

On July 16, the Medicare Fraud Strike Force made national headlines when 94 doctors, healthcare company owners, executives and others were charged for more than $251 million in alleged false billing nationwide.

The operation involving nearly 400 law enforcement agents from the FBI, HHS-OIG, multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies signaled the largest federal healthcare fraud takedown since Medicare Fraud Strike Force operations began in 2007. Medicare fraud-related offenses include conspiracy to defraud the Medicare program, criminal false claims, violations of the anti-kickback statutes and money laundering. The charges are based on a variety of fraud schemes, including physical therapy and occupational therapy schemes, home healthcare schemes, HIV infusion fraud schemes, and DME schemes.

Derrick Jackson, special agent in charge (SAIC) for the Atlanta region, which includes West Tennessee said the OIG office is seeing all types of Medicare fraud.

“We’ve worked a few psychiatry cases where individuals were going into senior citizen high-rises and performing so-called psychotherapy,” said Jackson. “We’re finding in some of those cases that they aren’t licensed therapists and also they’re basically providing games such as bingo, fishing trips, trips to the movies, but they’re billing Medicare for psychotherapy. We’ve been successful working a few cases in the Memphis area.”

Jackson said he’s not aware of DME cases being worked in the Memphis area, but didn’t rule out an investigation may be forthcoming. Root said another takedown day may occur next spring.

“There’s no common theme in Memphis,” said Jackson. “But I would encourage physicians to monitor their physician IDs, just like they do their social security number. It’s a very powerful ID, and if stolen, can be used just as their social security number and date of birth for identity theft.”

For example, even though some physicians in DME cases were involved in Medicare fraud by taking kickbacks and signing medical necessity forms for writing prescriptions for motorized wheelchairs, others didn’t. Jackson pointed out that physicians who were not guilty of participating in the fraudulent activity didn’t realize their identities were being used.

“Physicians should do proper research on companies that approach them with side businesses,” said Jackson. “We see where legitimate doctors are working for hospitals and may sign an agreement to work for a pharmacist or a DME company. They should do their due diligence to make sure these individuals are legitimate and actually providing the services they advertise, as opposed to just signing documents and getting paid for it.”

Physician IDs are also being compromised via the Internet, sometimes in tandem with beneficiary lists acquired on the black market, Jackson noted.

“There are cases where the doctors have absolutely no idea their information has been compromised and they’re being billed,” he said.
Since its inception in March 2007 in South Florida, the Strike Force has obtained indictments of more than 800 individuals and organizations that collectively have billed the Medicare program for more than $1.85 billion. In addition, HHS’s Centers for Medicare and Medicaid Services (CMS), working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

HHS Secretary Kathleen Sebelius credited the new tools in the Affordable Care Act—stiffer penalties and better information sharing—with helping to “stamp out Medicare fraud and protect beneficiaries and the American taxpayer.”

 

Tags:

Affordable Care Act, Bill Root, Centers for Medicare and Medicaid Services, CMS, Derrick Jackson., DME, durable medical equipment, Health Care Fraud Prevention and Enforcement Action Team, HEAT, HHS, HHS Secretary Kathleen Sebelius, HHS-OIG, Medicare Fraud Strike Force, Office of Investigations, Office of the Inspector General, OIG, U.S. Department of Health and Human Services

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