Healthcare Compliance Perspective – Healthcare Fraud:
Knowingly billing Medicare for services not provided is a violation of the False Claims Act. A Compliance Officer may mitigate the ability of a contracted provider to fraudulently use the nursing home’s or assisted living facility’s residents to perpetrate such fraud by requiring the contracted provider to sign a code of conduct requiring compliance with all federal and state laws, and by conducting regular, periodic audits of the services provided by the contractor to their residents.
A United States Attorney recently announced that a 55-year-old woman, from Webster, New York, had been sentenced in federal court for healthcare fraud in New Hampshire to three years of probation. The sentencing followed her conviction for fraudulently billing Medicare for reimbursement of services that were falsely described as “wound care” when they were only routine footcare services.
According to court documents, from 2006 to 2012, the woman owned and operated a business that provided physical therapy services to Medicare beneficiaries. Through the business, she provided routine foot care (e.g., toenail trimming, ingrown toenail repair and callus shaving) to patients in an assisted living facility in Bedford, New Hampshire. Knowing that the services were not covered by Medicare, the woman obtained payments totaling $41,127.89 by submitting claims for payment to Medicare that falsely described these routine services as wound care.
The woman previously pleaded guilty on December 18, 2017. As part of her sentence, she was ordered to pay restitution of $41,127.89
