Clinicians Ensnared In Multi-Million Dollar Fraud Schemes

fiercehealthpayer antifraud
February 16, 2016 | By Evan Sweeney

Clinicians across the country are facing fraud charges for multimillion dollar schemes that run the gamut of medical specialties, from obstetrics and gynecology to pain medicine. 

• A Miami physician pleaded guilty last week to a scheme in which Medicare paid out $20 million in fraudulent payments, according to the U.S. Attorney's Office for the Southern District of Florida. Henry Lora, M.D., served as the medical director for a Miami clinic known as Merfi Corporation. Lora and others wrote prescriptions for unnecessary home health services and falsified patient records in exchange for kickbacks. The owner of the clinic was sentenced to nine years in prison in 2014 for her role in the scheme.
• In New Jersey, an obstetrician gynecologist was charged with submitting millions in claims for rectal tests he never performed, according to NJ.com. Prosecutors say Dr. Labib E. Riachi showed a distinct pattern of overbilling, submitting more claims for the test to diagnose fecal incontinence than the next 10 highest billers in the state combined. The complaint also states Riachi billed for more than 500 procedures while he was traveling in Europe, and submitted claims for physical therapy that were never performed by a licensed therapist.  
• A New Mexico pain management physician linked to the death of four patients has pleaded guilty to charges that he wrote unnecessary prescriptions for oxycodone and methadone and billed Medicare and Medicaid for reimbursement, according to the Albuquerque Journal. Officials say Dr. Pawankumar Jain prescribed pain medication to four patients who later died of an overdose, including one in which Jain wrote two prescriptions for more than 500 tablets of methadone.
• A nurse in Pennsylvania was convicted for her role in a scheme that submitted nearly $10 million in fraudulent hospice claims to Medicare. A federal jury convicted Patricia McGill, who served as director of professional services for Home Care Hospice in Philadelphia, of authorizing hospice services for patients who were not medically eligible, according to the U.S. Attorney's Office for the Eastern District of Pennsylvania.

Home health and hospice fraud schemes have been on the radar of federal and state investigators, particularly in the Midwest, where authorities in Detroit and Chicago have targeted home health and hospice fraud. The Office of Inspector General and legislators have highlighted opioid prescribing as a key issue within Medicare Part D spending, while some state enforcement agencies have failed to investigate providers with a long history of overprescribing.

To learn more:
- here's the announcement from the U.S. Attorney's Office for the Southern District of Florida
- read the NJ.com article
- read the Albuquerque Journal article
- here's the announcement from the U.S. Attorney's Office for the Eastern District of Pennsylvania

Related Articles:

Amid a handful of overprescribing convictions, one doctor has a 30-year fraud history
House subcommittee grills OIG, CMS on Part D fraud and abuse
Home health, hospice, laboratory fraud dominate Midwest

Thank You Mr Sweeny and FHPAF.