Tag: Medicare fraud

NEWARK, N.J. – Two Florida men have been indicted for their roles in DME and compound medication schemes involving kickbacks and fraud, the Department of Justice and the U.S. Attorney’s Office for the District of New Jersey have announced. Thomas Farese of Delray Beach, Fla., and Domenic Gatto of Palm Beach Gardens, Fla., are charged in an 11-count indictment with conspiracy to commit wire fraud, conspiracy to commit health care fraud, conspiracy to transact in criminal proceeds, transacting...

WASHINGTON – The Department of Justice has announced criminal charges against 138 defendants for their alleged participation in various health care fraud schemes, including those involving telemedicine and DME, that have resulted in about $1.4 billion in alleged losses.  Of the total, 43 defendants have been charged for their participation in schemes involving telemedicine, resulting in $1.1 billion in alleged losses. Certain telemedicine execs allegedly paid doctors and nurse...

RALEIGH, N.C. – Shelly Phillips Bandy, co-owner of A Perfect Fit For You, a DME company based here, has been sentenced to 30 months in federal prison, followed by three years of supervised release on a charge of Making Material False Statements Relating to Healthcare Matters. In December, Bandy admitted to submitting fraudulent claims to Medicaid on behalf of A Perfect Fit.  Specifically, she admitted that on Jan. 1, 2016, she billed Medicaid for 43 fraudulent claims, totaling $626,773.79,...

HATTIESBURG, Miss. – Joy Beth Harden has pleaded guilty to one count of health care fraud. She was charged with submitting bills to Medicare and other health benefits programs since 2016 for DME that was neither prescribed nor delivered to patients, for her business, BZB LLC doing business as Duracare Home Medical Equipment. Harden, who will be sentenced Nov. 23, 2021, faces a maximum penalty of 10 years in federal prison and a $250,000 fine.

DELRAY BEACH, Fla. – A U.S. district judge has sentenced Dr. Richard Davidson of Delray Beach, Fla., to six years in federal prison for conspiracy to commit health care fraud. Davidson was charged with establishing a conglomerate of DME companies that were placed in the names of straw owners. By concealing the true ownership of the companies, he and his conspirators gained control of multiple companies, allowing them to submit high volumes of illegal DME claims, while attempting to evade law...

NEWARK, N.J. – Five individuals have been charged and two others have pleaded guilty for their roles in a $93 million kickback fraud scheme involving DME and genetic cancer screening, according to the U.S. Attorney’s Office for the District of New Jersey. Thomas Farese, Pat Truglia, Domenic Gatto, Nicholas Defonte and Christopher Cirri are each charged by complaint with conspiracy to commit health care fraud; while Brian Herbstman has pleaded guilty to conspiracy to commit health...

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...