Florida Healthcare Provider Pleads Guilty in Medicare Fraud Scheme
Providing prescriptions for home care services without a medical necessity for such services could lead to submission of false claims and charges of fraud.
Compliance Perspective – Medicare Fraud
Policies/Procedures: The Compliance and Ethics Officer with the Administrator will review policies and procedures involving contractors/vendors providing outside services to residents.
Training: The Compliance and Ethics Officer with the Administrator will ensure that staff are trained to respond in a timely manner to concerns about prescriptions for residents that do not appear to be necessary.
Audit: The Compliance and Ethics Officer with the Director of Nursing should conduct an audit of resident’s prescriptions/physician orders to determine if they are for necessary services and have appropriate indications.
The former owner of a Florida healthcare provider recently pleaded guilty in a conspiracy scheme to commit healthcare fraud and wire fraud. The $3.7 million scheme defrauded Medicare by submitting fraudulent billings and by referring patients to three home health agencies that also submitted fraudulent bills.
Government prosecutors said the defendant accepted kickbacks from patient recruiters and from owners of several other Florida home health agencies in exchange for providing prescriptions for home health services to patients at her healthcare facility.
The home health agencies used the prescriptions to bill Medicare for services supposedly provided to Medicare beneficiaries.
Other principals of the home health agencies, along with the physician who wrote the fraudulent prescriptions, pleaded guilty earlier to conspiracy to commit healthcare fraud.
