“Medicaid fraud in all its forms remains a statewide problem, ....

ALBANY–The industry-wide Medicaid fraud probe of the home health care industry has expanded upstate with the issuance of 27 subpoenas to western and central New York home health care providers. In addition, the investigation, known as “Operation Home Alone,” has resulted in the conviction of a Buffalo area home health agency employee, Rochester area nurse, and Syracuse area licensed practical nurse.

“Operation Home Alone” is the Attorney General’s long-term and statewide investigation into fraud in the home health care industry, which is one of New York’s fastest growing industries. Thus far, “Operation Home Alone” has resulted in charges against more than 80 defendants, including patients, aides, nurses, instructors, and the administrators of licensed and certified home health agencies. Defendants convicted during the investigation have been ordered to repay nearly $14 million in restitution.


and my office will continue using effective approaches to weed it out in all corners of New York,” said Attorney General Andrew Cuomo. “My office’s ‘Operation Home Alone’ investigation into the home health care industry has led to prosecutions both downstate and up. Taxpayers throughout the State cannot continue to shoulder the burden of unscrupulous companies and individuals that put patients at risk and rip off all New Yorkers.” This week the Attorney General issued 27 subpoenas to certified home health agencies in the Buffalo, Rochester, and Syracuse regions. These subpoenas seek information about home health aides whose services were paid for by Medicaid, including personal information, verification of qualifications, and the names of the licensed home care service agencies that supplied the aides for which the certified agencies billed.

The subpoenas follow a series of enforcement actions in the three regions. In Buffalo, investigators from the Attorney General’s Medicaid Fraud Control Unit arrested Melody McKnight, 26, an employment recruiter for an in-home health care training and services company. Among other crimes, McKnight sold falsified Personal Care Aide (PCA) certificates and further offered to have sex with an undercover investigator for $200 at a Buffalo hotel.

On April 1, McKnight pleaded guilty to attempted forgery in the second degree and commercial bribe receiving in the second degree. She is scheduled to be sentenced on June 10.

The Attorney General’s Office recently convicted a Rochester area nurse, Adrian Clements, 39, of grand larceny in the fourth degree. As part of her plea, Clements admitted to submitting reimbursement claims that falsely represented that she provided home nursing services to 10 Medicaid recipients - including five children under the age of 10. These false claims allowed her to steal $70,785 from the Medicaid program. Clements was sentenced to five years’ probation, four months of weekend incarceration, and restitution in the amount of $70,785.

Also in Rochester, the Attorney General’s Office has convicted one nurse and brought related charges against three others. Suzan Sheldon, 41, along with licensed practical nurses Michele Schug, 33, and Monica Webster, 36, and registered nurse Anna Reid, 58, were arrested and charged with grand larceny for falsely billing Medicaid for the care of a young adult patient in Onondaga County.

At various times over a four-year period, all four defendants cared for the same patient, a young adult with cerebral degeneration and pulmonary collapse who requires around-the-clock home care nursing services. Although the patient’s parents provided up to 12 hours of care daily, the nurses routinely split up among themselves the billing for those hours. The investigation found nearly $250,000 in payments for services that were not rendered.

On April 11, Sheldon, pleaded guilty to grand larceny in the third degree. She is scheduled to be sentenced on June 20. Charges against Reid, Schug, and Webster are pending.

“In each of these cases we see a pattern of patients being subjected to deficient care and aides committing acts of fraud that rob taxpayers of their hard earned dollars,” said Cuomo. “My office is taking action to root out Medicaid Fraud in Buffalo, Rochester, Syracuse and across the entire state. I am committed to ensuring that New York’s seniors receive the care they need and preventing our tax dollars from being wasted by fraud.”

Because Medicaid reimbursement for home health services is very generous, the costs of the program are a serious taxpayer expense. Last year alone, Medicaid expended $33,513,547 in Erie County, $56,056,948 in Monroe County, and $17,071,458 in Onondaga County on home health care for Medicaid recipients. Every month, more than 150,000 New Yorkers receive some sort of Medicaid-funded home health services. In 2007, Medicaid spent approximately $3.8 billion on home health care statewide. Moreover, because these services are provided outside an institution and therefore cannot be supervised, the home health care program is particularly prone to fraud.

“Operation Home Alone” has so far exposed a statewide range of fraudulent practices and schemes in the home health care industry by home health and personal care aides, the schools that train them, and the agencies that recruit and employ them. The crimes and frauds include the sale and distribution of falsified certifications, aides working without proper training or certifications, no-show aides who split their payments with complicit patients, aides billing multiple agencies for a total of up to 36 hours in one day, and nurses and certified home health agencies billing Medicaid for services never provided.

Along with the rigorous enforcement of current laws through initiatives like “Operation Home Alone,” Cuomo has also called for a statewide registry of certified home health aides to be developed and maintained by the state Department of Health.

The registry would enhance the State’s ability to oversee the industry, provide potential employers with the ability to screen home health aides, and help to detect and deter fraud. A registry already exists for nurse aides that work in nursing homes. By creating a registry for home health aides, this bill would extend the same protections that exist in the nursing homes to care-dependent persons being cared for in their homes.

New Yorkers are urged to report cases of suspected fraud to the Attorney General’s toll-free Medicaid Fraud Hotline, at 1-866-NYS-FIGHT (697-3444). 4-17-08

A panel to explore the latest developments in trends, practice issues related to health care fraud.? What a bizarre notion!

Description:
Join our three distinct panels as they explore the latest developments in practice issues related to health care fraud. Each panel will cover a separate set of topics.

Panel I: Trends in Health Care Fraud Enforcement

The first panel will discuss recent trends in health care fraud enforcement as well as initiatives aimed at preventing and detecting fraud and abuse.


Panel II: The Government's Role in Enforcing Health Care Quality
This panel will focus on quality of care issues, an increasing focus for the government's enforcement agencies, including the OIG, the Department of Justice and state Attorneys General. Panelists will discuss theories of criminal and civil liability for substandard care including, False Claim Act prosecutions for "failure of care” and provision of worthless services. Attendees will also learn about the violations of licensure laws for using unlicensed or unqualified personnel.


Panel III: Settlement Issues and RamificationsThe third panel will discuss settlement issues and ramifications. This panel will address issues to be considered when entering into settlement agreements with the government. Attendees will learn about the intricacies of sentencing and fine issues as well as the issue of potential exclusion from federal programs, corporate integrity agreements, and post-settlement monitoring. Panelists will provide insight on both the government's viewpoint, and the viewpoint of a practitioner experienced in negotiating such agreements.




Practice Areas: Government Law, Healthcare & Pharmaceuticals Law

Medical Support Services, MediSource, an AMSS vendor

Robert Rintoul, of Westlake, Ohio, was charged in a superseding indictment with fraud conspiracy, mail fraud, health care fraud, and witness tampering related to his involvement in a health care fraud scheme.

News Release

For Release: March 6, 2008

U.S. Department of Justice
United States Attorney
Northern District of Ohio

William J. Edwards
Acting United States Attorney

Justin J. Roberts
Assistant U.S. Attorney
(216) 622-3958



William J. Edwards, Acting United States Attorney for the Northern District of Ohio, today announced that a Superseding Indictment was filed charging Robert Rintoul with one count of Fraud Conspiracy, ten counts of Mail Fraud, twenty-seven counts of Health Care Fraud, and one count of Witness Tampering.

Rintoul, age 48, resides in Westlake, Ohio.

The Indictment states that Robert Rintoul, President of Advanced Medical Support Services, Inc. (“AMSS”), a medical supply provider located in Rocky River, Ohio, with a branch in Buffalo, New York, devised a scheme to defraud various health insurance companies, from late 2001, through about April 2007, by conspiring with others to submit fraudulent claims for reimbursement for products and services not provided.

The Indictment alleges that Rintoul requested and obtained fraudulent invoices from a co-conspirator at MediSource, an AMSS vendor located out of Sunbury, Ohio. The invoices were for items that AMSS never ordered or received from MediSource, or showed that AMSS paid a higher purchase price than it actually paid so Rintoul and AMSS could be reimbursed for the higher amount.

The Indictment further charges that AMSS and Rintoul billed the health care benefit programs for a greater number of items than were ordered and shipped and, in some instances, for items that AMSS never sold. These claims and invoices were submitted and caused AMSS and Rintoul to be paid in full, thereby receiving funds to which they were not entitled.

The Indictment further charges that Rintoul sought to prevent a witness, a fellow co-worker at AMSS, from communicating with law enforcement officers regarding the federal offenses of Health Care Fraud, Mail Fraud, and Conspiracy previously mentioned.

As of late 2007, two related defendants have entered into Plea Agreements with the United States Attorney’s Office. Robin Laszlo, Supervisor for Patient Supplies at AMSS, pled guilty in November 2007, to one count of Conspiracy to Commit Health Care Fraud. The Plea Agreement states that false claims were submitted to health care providers for products and services not provided, causing AMSS to receive funds to which they were not entitled.

Russell Latimer, President and Founder of MediSource, a vendor of AMSS, pled guilty in December 2007, to one count of Conspiracy to Commit Health Care Fraud and one count of Obstruction of a Criminal Health Care Investigation. In the Plea Agreement Latimer admits to preparing fraudulent invoices which AMSS then submitted to health insurance companies.

If convicted, the defendant’s sentence will be determined by the Court after review of factors unique to this case, including the defendants’ prior criminal records, if any, the defendants’ role in the offense and the characteristics of the violation. In all cases the sentence will not exceed the statutory maximum and in most cases it will be less than the maximum.

This case is being prosecuted by Assistant U.S. Attorney Justin J. Roberts, following investigation by the Cleveland office of the Federal Bureau of Investigation.

A Superseding Indictment is only a charge and is not evidence of guilt. A defendant is entitled to a fair trial in which it will be the government’s burden to prove guilt beyond a reasonable doubt.


http://cleveland.fbi.gov/dojpressrel/2008/healthfraud041508.htm

Attorney General Andrew Cuomo ....home-health care industry bills the state $3.8 billion a year in Medicaid costs,

Cuomo Issuing Subpoenas On Home Health Industry

Attorney General Andrew Cuomo just called to say he’s in Buffalo and Rochester today to announce that he’s issuing 27 subpoenas to home-health companies across upstate over allegations of fraud and mistreatment of patients.

Cuomo said the home-health care industry bills the state $3.8 billion a year in Medicaid costs, yet Cuomo believes there is “rampant fraud throughout the system.”

He mentioned instances where home-health agencies bill patients but never even show up. He said there’s one case in Rochester where there was $70,000 in over billing.

“It’s a double fraud,” Cuomo said. “It’s victimizing elderly people, disabled people who are home bound for the most part, and you rip off the taxpayers.”

He said the subpoenas will seek records and information from home-health care companies about their billing practices and work with patients.

The home-health care industry is the latest target by Cuomo, who earlier this week expanded his probe into whether local governments and schools are bilking taxpayers by putting consultants on the payroll in order to receive state benefits, such as health care and pensions.

FBI raids three local health care offices

FBI raids three local health care offices

Last Update: 4/14 9:29 pm

PINELLAS COUNTY -- Today, federal search warrants were executed at local pharmacies in Madeira Beach, Clearwater, and Seminole.

Authorities have teamed up to investigate multi-million dollar health care fraud allegations involving local pharmacies.

These pharmacies are accused of illegally manufacturing and distributing drugs along with mail, health care and wire fraud.




Copyright 2008 The E.W. Scripps Co. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

2003, "Tenet received a subpoena from the Department of Justice seeking Medicare documents dating back to early 1997. "

I love these corportions with thier threats of closed doors, lost jobs, etc.....all in the name of GREED!!!!!

Wednesday, July 16, 2003
Tenet receives more subpoenasLos Angeles Business from bizjournals
Santa Barbara-based Tenet Healthcare Corp. and several of its subsidiaries received subpoenas Tuesday from the U.S. Attorney's office in Los Angeles seeking information about physician relocation agreements.

Dating back to 1995, the information relates to seven Southern California hospitals owned by Tenet. Los Angeles officials also are seeking information about relocation agreements for all of Tenet's hospital subsidiaries. The health-care provider operates 114 acute care hospitals in 16 states.

Tenet says it does "not know the scope or focus of the investigation underlying the subpoenas," but it has pledged cooperation with investigators. The company is under investigation by the Securities and Exchange Commission over Medicare outlier payments, stop-loss payments, increases in gross charges and financial disclosures. Outlier payments are additional payments from Medicare to hospitals for high-cost Medicare cases.

In January, Tenet received a subpoena from the Department of Justice seeking Medicare documents dating back to early 1997. The Department of Health and Human Services and the Federal Trade Commission began investigations of the company in 2002.

Tenet also says it may be indicted in San Diego over its Alvarado Hospital Medical Center Inc. and its corporate entities, again over physician relocation policies.

Tenet says its physician relocation agreements policy is "entirely appropriate under the law." Only a fraction of its 42,000 physicians fall under the agreement, Tenet adds.

In debt by some $4.1 billion, Tenet has said it would sell or shutter up to 14 of its hospitals and shave $100 million a year in expenses by cutting jobs, reducing travel costs and selling two of its three corporate jets. The company replaced its CEO earlier this year.
Tenet operates 18 hospitals in the metro Los Angeles area, including USC University Hospital, Century City Hospital and Midway Hospital Medical Center.

South Texas couple convicted of Medicare and Medicaid fraud

South Texas couple convicted of Medicare and Medicaid fraud

I wonder, How long did it take the U.S. Attorney's office to unveil this? I am sure, TOOOOO LONG!!!!!


Associated Press - April 14, 2008 3:05 PM ET

McALLEN, Texas (AP) - A former South Texas county commissioner and his wife have been convicted of conspiracy to commit health care fraud for billing Medicare and Medicaid $14 million in false claims from their ambulance companies.

The U.S. Attorney's Office said Monday that Guadalupe Garces Jr., a former Hidalgo County commissioner, and Araceli Garces used their Edinburg ambulance companies to transport people to and from dialysis clinics when ambulance transport was not necessary.

Once Medicare and Medicaid stopped reimbursing A-Stat Ambulance Inc., the couple formed A-Care E.M.S. Inc. in the name of their 20-year-old son.

Both face up to 10 years in prison, a maximum $250,000 fine and restitution.

Copyright 2008 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.