Healthcare Compliance Perspective:
Compliance Officers must focus on ensuring that products and services are provided for which Medicare/Medicaid reimburses for.
An operator of multiple, purported durable medical equipment (DME) companies pled guilty last week to fraud charges for her role in a scheme to defraud a non-profit, New York-based health maintenance organization that administers Medicare Advantage plans and New York Medicaid Managed Care plans.
The accused woman from Maryland pled guilty to one count of conspiracy to commit healthcare fraud before a U.S. District Judge in the Eastern District of New York. Sentencing has been scheduled for March 21, 2018 before the judge.
As part of her guilty plea, the woman admitted that she operated a series of purported DME companies that did not in fact provide equipment to any beneficiaries. She further admitted that she and others called the healthcare non-profit, falsely representing themselves as vendors in the organization’s network. The companies the woman operated submitted almost $1 million in false claims to the non-profit for reimbursement, and she admitted to receiving more than $300,000 related to those false claims.
