A New York optician has pled guilty to grand larceny for submitting false claims for optician services that he alleged were for specific nursing home residents, but which were never provided. Many of the residents for whom the optician submitted claims were deceased, and he never visited the nursing homes on the dates of the those claims.
The optician fraudulently received approximately $74,000 in Medicaid payments between 2016 and 2019 by billing for the optician services that were not provided. The Office of Attorney Generalās investigation revealed that many of the patients for whom the optician claimed to have fitted eyeglasses were actually deceased on the dates he claimed to have serviced them, and that he even continued billing for services multiple times after those dates. Additionally, nursing home visitor logs and records revealed that the optician never visited the nursing homes on dates he claimed to have provided the resident services.
The New York optician pled guilty to grand larceny in the fourth degree, a class E felony. On January 27, 2022, he was sentenced to 90 days in state prison, followed by 5 yearsā probation, and was ordered to pay $74,00 in restitution.
Issue:
It is extremely important that all members of the healthcare team are aware of what may be considered a false claim. Failure to promptly report a false claim can result in lawsuits, fines, and other sanctions. Additionally, it is necessary that the billing office ensures that no double billing occurs by the nursing home and any consultant. Additional information is available in the Med-Net Corporate Compliance and Ethics Manual, Chapter 1 Compliance and Ethics Program, CP 2.3 General Legal Duties and Antitrust Laws.
Discussion Points:
- Review your facilityās policies and procedures for preventing and reporting a false claim violation. Update your policies and procedures as needed.
- Train all staff on the False Claims Act and what can be considered a false claim. Include information on how to report concerns and suspected violations, and that prompt reporting is mandatory. Document that the trainings occurred and place in each employeeās education file.
- Periodically audit staff to ensure that they are aware of what should be done if they suspect a false claim has occurred, whether intentionally or unintentionally. Conduct audits of documentation and billing routinely to prevent and detect errors before they progress to false claims.
