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Tag: Fraud


News

In brief: CMS makes advance payments, state AG sues Apria, OIG warns of cath scams 

March 13, 2024HME News Staff

WASHINGTON – CMS on March 9 made available Change Healthcare/Optum Payment Disruption (CHOPD) accelerated payments to Part A providers and advance payments to Part B suppliers experiencing claims disruptions.  The payments may be granted in amounts representative of up to 30 of claims payments to eligible providers and suppliers. The average 30-day payment is based on the total claims paid to the provider/supplier between Aug. 1, 2023, and Oct. 31, 2023, divided by three. These payments...

advance payments, Apria, Catheter, Change Healthcare, Cyberattack, Data Breach, Fraud


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OIG publishes ‘Consumer Alert’ for cath scams 

March 11, 2024HME News Staff

WASHINGTON – The Office of Inspector General is alerting the public about a fraud scheme involving urinary catheters. In a “Consumer Alert,” the agency says scammers are targeting Medicare enrollees through phone calls, Internet ads and text messages with offers of free services, medical equipment or gift cards upon confirming their personal information and eligibility for specific Medicare services. Often, the enticement for the individual is that they are “qualified”...

Catheter, Fraud, Office of Inspector General (OIG)


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AAHomecare supports detection efforts in wake of cath fraud reports

March 7, 2024HME News Staff

WASHINGTON – AAHomecare has issued a statement affirming its support for the government to implement real-time monitoring of claims to detect potential fraud and abuse in response to news reports of potential Medicare fraud by a handful of intermittent catheter companies.  AAHomecare's statement, which was shared with CMS and Capitol Hill, also reiterates recommendations for federal government initiatives to better monitor DME supplier billing practices and trends, including:  Increased...

AAHomecare, Fraud, Intermittent catheters


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Georgia man pleads guilty to $127M fraud scheme

December 21, 2023HME News Staff

NEWARK, N.J. – Nicco Romanowski, of Roswell, Ga., pleaded guilty to conspiracy to violate the federal anti-kickback statute and conspiracy to commit health care fraud. From June 2017 through May 2019, Romanowski participated in a scheme with DME companies, telemedicine companies and doctors to submit false claims to health care benefit programs, including Medicare and Tricare. In total, Romanowski and his conspirators caused the submission of false and fraudulent claims to health care benefit...

Fraud, Medicare


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Physician charged with receiving more than $13M in fraudulent payments

December 6, 2023HME News Staff

SPOKANE, Wash. – Thomas Andrew Webster, M.D., of Sylvania, Ohio, has been charged by with one count of conspiracy to violate the Anti-Kickback Statue in connection with a fraudulent medical supply scheme that targeted elderly Medicare and TRICARE beneficiaries throughout Washington and in other states. According to charges announced by Vanessa R. Waldref, the United States Attorney for the Eastern District of Washington, between May 2021 and September 2023, “Company A” allegedly...

Fraud


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OIG warns of RPM scam 

November 27, 2023HME News Staff

WASHINGTON – The Office of Inspector General has posted a consumer alert about a fraud scheme involving monthly billing for remote patient monitoring. The OIG says unscrupulous companies are signing up Medicare beneficiaries for monitoring using medical devices like scales, glucose monitors, blood pressure cuffs, cardiac rhythm devices and other equipment, regardless of medical necessity. The agency says these companies are signing up bennies for these services in several ways, including phone...

consumer alert, Fraud, Office of Inspector General (OIG), Remote Patient Monitoring


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Two plead guilty in brace scheme 

November 14, 2023HME News Staff

ATLANTA – Brett Weiner and Valerie Desalvo have pleaded guilty to federal conspiracy charges for their role in buying and selling fake doctors’ orders used to obtain more than $1.5 million in fraudulent payments from Medicare, according to the U.S. Attorney’s Office for the Northern District of Georgia. Weiner and Desalvo owned and operated Laboratory Marketing Services, a business in Boca Raton, Fla., that, among other things, received kickback payments in exchange for patient...

Braces, Fraud, Medicare


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Nurse charged with brace scheme 

October 10, 2023HME News Staff

BOSTON – A Virginia-based nurse practitioner has been charged with one count of conspiracy to commit health care fraud in connection with a $7.8 million telemedicine fraud scheme involving medically unnecessary DME, including back and knee braces. According to charging documents, between December 2018 and April 2020, Daphne Jenkins worked with a telemedicine company to sign orders for medically unnecessary DME. She allegedly signed orders that were pre-populated based on telemarketing calls...

Braces, Fraud


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Two charged in Medicare scam for power mobility

August 31, 2023HME News Staff

 BROWNSVILLE, Texas – Maria Luisa Yzaguirre and Jeremiah Yzaguirre, both of Harlingen, Texas, have been charged with conspiracy to commit health care fraud, aggravated identity theft and money laundering. The charges allege that between 2019 and 2023, the Yzaguires submitted more than $14 million in claims to Medicare for power wheelchairs, power scooters, parts and repairs for 37 individuals. In multiple instances, they allegedly billed Medicare more than $600,000 for parts and repairs...

Fraud, Medicare, Power mobility devices


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Florida man pleads guilty to fraud

August 24, 2023HME News Staff

 TRENTON, N.J. – Patrick Fitchner of Orlando, Fla., pleaded guilty Aug. 22 to one count of conspiracy to commit health care fraud in Trenton federal court. Fitchner and his conspirators solicited and received kickbacks and bribes in exchange for providing DME companies with completed doctors’ orders for medically unnecessary DME, such as orthotic braces, using telemedicine companies to obtain the prescriptions. The DME orders were subsequently fraudulently billed to Medicare and...

Fraud, Medicare


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