Feds continue to roll over fraud

Sunday, October 30, 2005

YARMOUTH, Maine - The Health Care Fraud and Abuse Control Program continues its success in prosecuting cases of DME and other kinds of healthcare fraud, the agency reported earlier this month.

In fiscal year 2004, the federal government won or negotiated $605 million in judgments and settlements. In its eight-year existence, the HCFAC has returned more than $7.3 billion to the Medicare Trust fund.

Recent successes for HCFAC include a $382 million payment from Abbott Laboratories to the federal government and $32 million to the 50 states and Washington D.C. to resolve claims that its Ross Products Division defrauded Medicare and Medicaid over a 10-year period in connection with enteral feeding products. CG Nutritionals, a division of Ross, pleaded guilty to obstruction of a criminal investigation, paid a $200 million fine and was placed on five year's probation.

Wheelchairs remain a popular fraud item.

A Santa Monica wheelchair repair shop owner was one of four defendants, including a physician, convicted of fraud in California, billing Medicare approximately $2.6 million for wheelchairs, accessories and hospital beds that were not medically necessary and often never delivered.

Also convicted in wheelchair fraud were five defendants in Texas as a result of "Operation Roll Over." In the multi-million dollar scheme, suppliers would use patients' Medicare information to file fraudulent claims. The suppliers usually billed Medicare for expensive motorized wheelchairs to the tune of $8,000 to $10,000 and received $5,000. Some patients received less expensive scooters while many never received anything, nor did they ask for such items.

And, in Florida, seven defendants pleaded guilty in a fraud scheme that resulted in $5 million in false Medicare claims for power wheelchairs. Patients received kickbacks to act as wheelchair recipients, in some cases even receiving the chairs in staged deliveries. The chairs were later retrieved fraud organizers. All seven received prison terms ranging from 87 to 78 months. The two organizers and their top recruiter must pay $1.7 million in restitution. The other four will pay restitution in amounts ranging from $406,000 to $867,000.