Tag: medicare fraud

I received a press release last week from the DOJ about the latest news in Medicare fraud involving, what else, braces! Juan Camilo Perez Buitrago and two of his employees submitted more than $109 million in false claims for arm, back, knee and shoulder braces. (nothing to see here). But it’s the details that really made me say, WTF? You see, as part of his scheme, Buitrago had the employees, Jessica Jones and Elizabeth Putulin, list his wife, mother and yacht captain as directors for...

WASHINGTON - Liz Richter has been named acting administrator of CMS and Norris Cochran has been named acting secretary of the Department of Health and Human Services.  Richter is an agency veteran who has worked at CMS since 1990, most recently as deputy center director for the Center for Medicare. She began in the Bureau of Policy Development working on inpatient hospital payment policy. She subsequently worked on a variety of Medicare payment issues. She has also served as director of the...

BOSTON – Two women have pleaded guilty to charges they participated in a scam to defraud Medicare of more than $109 million by filing false claims for orthotic braces. Jessica Jones, 30, of Louisville Colo., and Elizabeth Putulin, 30, of Coconut Creek, Fla., who have each pleaded guilty to one count of conspiracy to commit health care fraud, conspired with their employer, Juan Camilo Perez Buitrago, to submit more than $109 million in false and fraudulent claims for DME, such...

WASHINGTON - CMS says its aggressive corrective actions have led to an estimated $15 billion reduction in Medicare fee-for-service improper payments since 2016. The Medicare fee-for-service estimated improper rate decreased to 6.27% in fiscal year 2020, compared to 7.25% in FY 2019, the fourth consecutive year the rate has been below the 10% threshold for compliance established in the Payment Integrity Information Act of 2019. “We must ensure that fraud and abuse doesn't rob the program of...

WASHINGTON - CMS has issued a final rule that creates several new revocation and denial authorities to bolster the agency's efforts to stop waste, fraud and abuse in Medicare, Medicaid and CHIP.The Program Integrity Enhancements to the Provider Enrollment Process, CMS-6058-FC, contains a new “affiliations” authority that allows CMS to identify individuals and organizations that pose an undue risk of fraud, waste and abuse based on their relationships with other previously sanctioned entities....

HOUSTON- Angel Mirabal, of Miami, was arrested Sept. 26 on charges of scheming to defraud Medicare. From April 2013 to July 2013, Mirabal allegedly conspired to bill Medicare $24 million in fraudulent claims for reimbursement through Quick Solutions Medical Supplies. According to the indictment said Mirabal and his co-conspirators used fraudulent shell companies to launder and disburse the proceeds from the health care fraud scheme.

LOS ANGELES - Vahe Tahmasian has been sentenced to 121 months in prison after being convicted of conspiracy to commit health care fraud, six counts of health care fraud and six counts of aggravated identity theft, according to a press release from the U.S. Department of Justice. Between April 2009 and February 2011, Tahmasian and co-conspirator Erik Mkhitarian, owners of Orthomed Appliance, a DME supply company in West Hollywood, allegedly stole the identity of beneficiaries and doctors from patient...

BATON ROUGE, La. - A federal court jury has found Ahaoma Boniface Ohia, owner of All-Star Medical Supplies, guilty of wire fraud, it was announced June 12. Ohia was accused of billing Medicare for durable medical equipment that was less expensive than what was provided or that wasn't provided at all, according to a press release. Ohia, who was taken into custody after the verdict, faces up to 140 years in prison, fines of up to $1.75 million, and restitution to victims.

WASHINGTON - The Medicare Fraud Strike Force has charged 90 individuals with $260 million in false billings, according to a May 13 release from the Department of Justice. Those charged include physicians, nurses and other medical professionals.“The crimes charged represent the face of health care fraud today—doctors billing for services that were never rendered, supply companies providing motorized wheelchairs that were never needed, recruiters paying kickbacks to get Medicare billing...

WASHINGTON - Jacob Kilgore, former co-owner of Salt Lake City-based Orbit Medical, has been indicted for his role in a $20 million Medicare fraud scheme, justice department officials have announced. The government alleges that between September 2008 and June 2011, Orbit Medical submitted false and fraudulent power wheelchair claims to Medicare. The company made $20 million in false claims; Medicare paid $15 million. Former Orbit sales representatives Morgan Workman, David Evans and Hunter Hartman...