No wonder FRAUD is "OUT OF CONTROL"!!!
Many Hospital Claims Denials by Recovery Audit Contractors Are Overturned, as Process Itself Is Questioned
Hospitals may be able to fend off recovery audit contractor (RAC) claims denials for medically unnecessary admissions or services because some of them have been overturned, experts tell RMC.
Washington, DC (PRWEB) July 17, 2008 -- AIS's Report on Medicare Compliance (RMC) - Hospitals may be able to fend off recovery audit contractor (RAC) claims denials for medically unnecessary admissions or services because some of them have been overturned, experts tell RMC. If RACs are too quick to reject admissions because they don't meet screening criteria (e.g., InterQual) without looking at the entire medical record, hospitals may be able to reverse them. The best approach, however, is to have an effective up-front process that provides ample documentation of the decision making behind an inpatient admission as described in the Medicare Benefit Policy Manual. To read the full story, go to http://www.aishealth.com/Bnow/hbd070308.html.
Meanwhile, there's evidence that RACs may rush to judgment about some inpatient admissions, physician, Robert Corrato, M.D., CEO of Executive Health Resources tells RMC. For example, CMS appeals contractors and administrative law judges overturned more than 1,000 RAC claims denials appealed by hospitals in four states toward the end of the RAC pilot, which wrapped up in March, says Corrato, whose organization helped the hospitals mount appeals. The hospitals were able to prove that the admissions and/or services were medically necessary, he says.
However, CMS says that only 5% of RAC determinations were overturned on appeal from the beginning of the pilot through Oct. 31, 2007. "CMS does not expect this number to change significantly once the evaluation report of the three-year demonstration is released," a CMS official tells RMC. About 40% of the overpayments identified by RACs were based on their assertions that the services lacked medical necessity. But Corrato notes that "when the 5% figure was computed, very few cases had advanced to the third level of appeal (the ALJ)" and "CMS's own statistics...indicate that 44.2% of appealed cases were decided in favor of the provider."
This article has been excerpted from AIS's Report on Medicare Compliance (RMC). To access the story in its entirety, visit http://www.aishealth.com/Bnow/hbd070308.html.
About Report on Medicare Compliance
Published by Atlantic Information Services, Report on Medicare Compliance is written by veteran compliance editor and reporter, Nina Youngstrom. Since 1992, this award-winning weekly newsletter has been the industry's #1 source of compliance news and strategies ... on medical necessity, physician payments, DRG coding, quality of care, observation billing, Stark and more.
Monday, July 28, 2008
Saturday, July 26, 2008
America’s Health Insurance Plans , Patient Privacy Rights said the revised bill is being reviewed and declined comment ....
House Energy and Commerce Committee Chair John Dingell (D-Mich.) and ranking member Joe Barton (R-Texas) on Tuesday released a revised version of a bill (HR 6357) that aims to promote nationwide adoption of an electronic health record system, CongressDaily reports. According to CongressDaily, the lawmakers “substantially changed the information-sharing and privacy provisions of their proposal” following “concerns from stakeholders in the health care, high-tech and consumer advocacy arenas.” The bill is scheduled for a full committee mark up on Wednesday (Noyes, CongressDaily, 7/22).
Under the revised bill, patients would give their consent only once to health care companies that want to access health care records without identifying information for HHS-approved purposes, such as hospital audits or fraud and abuse allegations. The bill previously would have required patient consent each time the records were accessed (Young, The Hill, 7/22). According to the revised bill, the patient consent provision would be implemented two years after the bill is enacted, and HHS would be required to develop “reasonable and workable” rules to implement the provision.
The original version of the bill also would have required health care providers to notify patients of any unauthorized acquisition, access or disclosure of their health care information. The revised version states that a “good faith” disclosure, such as a mislabeled letter with a wrong address, would not be considered a breach.
Other revised provisions in the bill would:
Prohibit the sale of patients’ records without consent unless it is necessary for treatment or to receive payment for treatment;
Change existing federal privacy laws to allow for the provision of a no-cost digital copy of an individual’s medical record;
Strengthen language to ban direct and indirect payments to providers who advertise health care products to patients without permission; and
Require the HHS Office of Civil Rights to launch a formal investigation of complaints and allow the office to impose fines for violations deemed “willful neglect” (Noyes, CongressDaily, 7/22).
Comments
House Energy and Commerce Subcommittee on Health ranking member Nathan Deal (R-Ga.) said the bill could advance on Wednesday. Deal said, “I think we worked out most of the big issues, barring amendments that come in and change that balance,” adding, “Assuming the mark up goes fairly smoothly this week … we probably would see it maybe even in the form of a suspension on the floor” (Armstrong, CQ Today, 7/22).
Mary Grealy, president of the Healthcare Leadership Council — who on Monday sent a letter to Dingell and Barton stating her concerns about the proposed bill’s effect on the Confidentiality Coalition — said, “They did make improvements in those provisions we had some concerns about, so I do feel like we’re making progress.” However, she added, “Do I think they have completely addressed all the issues? No” (The Hill, 7/22).
A spokesperson for America’s Health Insurance Plans said the provision that would allow patients to access their medical records and require them to provide consent for third-party access could restrict health care providers from developing wellness, disease management, quality assurance and other essential programs (CongressDaily, 7/22). A spokesperson for Patient Privacy Rights said the revised bill is being reviewed and declined comment (The Hill, 7/22).
Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.
Under the revised bill, patients would give their consent only once to health care companies that want to access health care records without identifying information for HHS-approved purposes, such as hospital audits or fraud and abuse allegations. The bill previously would have required patient consent each time the records were accessed (Young, The Hill, 7/22). According to the revised bill, the patient consent provision would be implemented two years after the bill is enacted, and HHS would be required to develop “reasonable and workable” rules to implement the provision.
The original version of the bill also would have required health care providers to notify patients of any unauthorized acquisition, access or disclosure of their health care information. The revised version states that a “good faith” disclosure, such as a mislabeled letter with a wrong address, would not be considered a breach.
Other revised provisions in the bill would:
Prohibit the sale of patients’ records without consent unless it is necessary for treatment or to receive payment for treatment;
Change existing federal privacy laws to allow for the provision of a no-cost digital copy of an individual’s medical record;
Strengthen language to ban direct and indirect payments to providers who advertise health care products to patients without permission; and
Require the HHS Office of Civil Rights to launch a formal investigation of complaints and allow the office to impose fines for violations deemed “willful neglect” (Noyes, CongressDaily, 7/22).
Comments
House Energy and Commerce Subcommittee on Health ranking member Nathan Deal (R-Ga.) said the bill could advance on Wednesday. Deal said, “I think we worked out most of the big issues, barring amendments that come in and change that balance,” adding, “Assuming the mark up goes fairly smoothly this week … we probably would see it maybe even in the form of a suspension on the floor” (Armstrong, CQ Today, 7/22).
Mary Grealy, president of the Healthcare Leadership Council — who on Monday sent a letter to Dingell and Barton stating her concerns about the proposed bill’s effect on the Confidentiality Coalition — said, “They did make improvements in those provisions we had some concerns about, so I do feel like we’re making progress.” However, she added, “Do I think they have completely addressed all the issues? No” (The Hill, 7/22).
A spokesperson for America’s Health Insurance Plans said the provision that would allow patients to access their medical records and require them to provide consent for third-party access could restrict health care providers from developing wellness, disease management, quality assurance and other essential programs (CongressDaily, 7/22). A spokesperson for Patient Privacy Rights said the revised bill is being reviewed and declined comment (The Hill, 7/22).
Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.
.....problem that costs the healthcare system an estimated $60 billion a year at the lowest estimate, and perhaps as much as $200 billion a year,.....
Healthcare fraud doesn’t even get a mention in the recently released government plan for creating a nationwide health information network.
REALLY? My same sentiments regarding the CAMPAIGN and FIXING the HEALTHCARE SYSTEM in this country.
Tackle fraud issue now, IT leaders advise
Jul 25th, 2008 | By Vantage Technology | Category: Healthcare IT
Healthcare fraud doesn’t even get a mention in the recently released government plan for creating a nationwide health information network.
Donald W. Simborg, MD, headed a team that worked on the problem of fraud for the Office of the National Coordinator. It’s a problem that costs the healthcare system an estimated $60 billion a year at the lowest estimate, and perhaps as much as $200 billion a year, Simborg told an audience at the 3rd Annual Leadership Summit on The Road to Interoperability, held in Boston earlier this week
Simborg chaired a follow-up panel that came up with a list of 14 specific recommendations that could be built into the review process used by the Certification Commission for Healthcare Information Technology.
“So what happened to our recommendations?” Simborg asked. “Well, it got a lot of push-back.”
On some level, Simborg expected resistance. Requiring fraud protections would perhaps slow the already snail-like pace of EMR adoption - at 4 percent, compared with 90 percent in every other industrialized country, according to David Bates, MD, medical director at the Harvard University-affiliated Partners HealthCare in Boston.
“What I didn’t expect was that (the Office of the National Coordinator) would totally drop fraud management from its plan,” Simborg said. “What I can’t understand is why we don’t try to solve this problem.”
“What I find astounding,” said Reed Gelzer, MD, a member of CCHIT’s privacy and compliance panel and co-founder of Advocates for Documentation Integrity and Compliance, “we are essentially suggesting our healthcare organizations adopt systems for which there are virtually no standards and minimal certifications. Where’s the discussion of the fact that we are killing 50,000 to 100,000 people a year?”
Simborg, who has been a vocal supporter of EHR adoption for more than 30 years, is a co-founder and member of Health Level 7, a founding member of the American College of Medical Informatics and a board member of the Foundation on Research and Education at the American Health Information Management Association (AHIMA).
In his view, the focus on promoting adoption, which goes back to President George W. Bush’s mention of electronic medical records in his State of the Union Address in 2004, might prove fruitless.
“Unless the focus changes,” he said, “adoption of electronic health records will lead to higher healthcare costs without much benefit. Without proactive fraud management, whatever the problem is will be much greater in an electronic environment.”
Beyond that, there are other issues.
The physician savings derived from electronic health records most often come from coding increases - what Simborg called “E&M code creep.” The E&M stands for evaluation and management.
“We need to have fundamental changes in how we pay physicians,” Simborg said.
While electronic health records provide a legitimate way for physicians to speed up their documentation, they also increase costs, he said.
He noted that when he developed a commercial EHR for oncologists, “our customers had an increase in billing that provided ROI in two years. More than half came from coding increases.”
Simborg suggests that adoption per se is not the goal.
“If driving value means slower adoption, that’s OK,” he said.
He recommends continuing “what we do right:”
Work on interoperability and certification;
Eliminate E&M payments based on volume of documentation;
Promote P4P models;
Build in decision-support and add incentives based on documented behavior change (over time, though, even that can be gamed, he said);
And tackle the issue of fraud management.
“Clearly we have to put fraud management in there somewhere,” he said. “The elephant has to be slain.”
“The issue is patient literacy,” said Charles Jaffe, MD, chief executive officer of HL7. “When we put down our list of to-dos, let’s make sure there are others in the equation besides providers.”
REALLY? My same sentiments regarding the CAMPAIGN and FIXING the HEALTHCARE SYSTEM in this country.
Tackle fraud issue now, IT leaders advise
Jul 25th, 2008 | By Vantage Technology | Category: Healthcare IT
Healthcare fraud doesn’t even get a mention in the recently released government plan for creating a nationwide health information network.
Donald W. Simborg, MD, headed a team that worked on the problem of fraud for the Office of the National Coordinator. It’s a problem that costs the healthcare system an estimated $60 billion a year at the lowest estimate, and perhaps as much as $200 billion a year, Simborg told an audience at the 3rd Annual Leadership Summit on The Road to Interoperability, held in Boston earlier this week
Simborg chaired a follow-up panel that came up with a list of 14 specific recommendations that could be built into the review process used by the Certification Commission for Healthcare Information Technology.
“So what happened to our recommendations?” Simborg asked. “Well, it got a lot of push-back.”
On some level, Simborg expected resistance. Requiring fraud protections would perhaps slow the already snail-like pace of EMR adoption - at 4 percent, compared with 90 percent in every other industrialized country, according to David Bates, MD, medical director at the Harvard University-affiliated Partners HealthCare in Boston.
“What I didn’t expect was that (the Office of the National Coordinator) would totally drop fraud management from its plan,” Simborg said. “What I can’t understand is why we don’t try to solve this problem.”
“What I find astounding,” said Reed Gelzer, MD, a member of CCHIT’s privacy and compliance panel and co-founder of Advocates for Documentation Integrity and Compliance, “we are essentially suggesting our healthcare organizations adopt systems for which there are virtually no standards and minimal certifications. Where’s the discussion of the fact that we are killing 50,000 to 100,000 people a year?”
Simborg, who has been a vocal supporter of EHR adoption for more than 30 years, is a co-founder and member of Health Level 7, a founding member of the American College of Medical Informatics and a board member of the Foundation on Research and Education at the American Health Information Management Association (AHIMA).
In his view, the focus on promoting adoption, which goes back to President George W. Bush’s mention of electronic medical records in his State of the Union Address in 2004, might prove fruitless.
“Unless the focus changes,” he said, “adoption of electronic health records will lead to higher healthcare costs without much benefit. Without proactive fraud management, whatever the problem is will be much greater in an electronic environment.”
Beyond that, there are other issues.
The physician savings derived from electronic health records most often come from coding increases - what Simborg called “E&M code creep.” The E&M stands for evaluation and management.
“We need to have fundamental changes in how we pay physicians,” Simborg said.
While electronic health records provide a legitimate way for physicians to speed up their documentation, they also increase costs, he said.
He noted that when he developed a commercial EHR for oncologists, “our customers had an increase in billing that provided ROI in two years. More than half came from coding increases.”
Simborg suggests that adoption per se is not the goal.
“If driving value means slower adoption, that’s OK,” he said.
He recommends continuing “what we do right:”
Work on interoperability and certification;
Eliminate E&M payments based on volume of documentation;
Promote P4P models;
Build in decision-support and add incentives based on documented behavior change (over time, though, even that can be gamed, he said);
And tackle the issue of fraud management.
“Clearly we have to put fraud management in there somewhere,” he said. “The elephant has to be slain.”
“The issue is patient literacy,” said Charles Jaffe, MD, chief executive officer of HL7. “When we put down our list of to-dos, let’s make sure there are others in the equation besides providers.”
$156,000 in restitution , and PROBATION!!
Health care fraud gets Washington County man three-year probationBy The Tribune-Review
Saturday, July 26, 2008
A Washington County man was sentenced in federal court Friday to three years' probation for health care fraud.
U.S. District Judge Gary L. Lancaster placed John Slimick, 49, of New Eagle on house arrest for six months. Slimick was ordered to pay $156,000 in restitution to Highmark Blue Cross Blue Shield and to perform 120 hours of community service.
Slimick is one of more than a dozen people convicted of taking kickbacks from former Lower Burrell chiropractor Douglas Henderson, who billed the insurance company for treatment never performed. Henderson, who submitted more than $7 million in false claims, is awaiting sentencing.
Saturday, July 26, 2008
A Washington County man was sentenced in federal court Friday to three years' probation for health care fraud.
U.S. District Judge Gary L. Lancaster placed John Slimick, 49, of New Eagle on house arrest for six months. Slimick was ordered to pay $156,000 in restitution to Highmark Blue Cross Blue Shield and to perform 120 hours of community service.
Slimick is one of more than a dozen people convicted of taking kickbacks from former Lower Burrell chiropractor Douglas Henderson, who billed the insurance company for treatment never performed. Henderson, who submitted more than $7 million in false claims, is awaiting sentencing.
Thursday, July 24, 2008
$60 Million to Settle False Claims Act and they still are BILLING!!!
What is wrong with this picture?
And they are allowed to still OPERATE and BILL MEDICARE/MEDICAID!!!
As part of the $60 million settlement, Cox has entered into a Corporate Integrity Agreement with the U.S. Department of Health and Human Services (HHS) Office of Inspector General. The Corporate Integrity Agreement contains measures to ensure compliance with Medicare regulations and policies in the future.
Missouri Health Care System to Pay U.S. $60 Million to Settle False Claims Act Allegations
July 23, 2008
Lester E. Cox Medical Centers, a health care system headquartered in Springfield, Mo., has agreed to pay the United States to settle claims that it violated the False Claims Act, the Anti-Kickback Statute and the Stark Statute between 1996 and 2005, by entering into certain financial relationships with referring doctors at a local physician group and engaging in improper billing practices with respect to Medicare. Cox, a not-for-profit healthcare organization, will pay the United States $60 million to resolve these claims.
Under the Stark Statute, Medicare providers like Cox are prohibited from billing the federal health care program for referrals from doctors with whom the providers have a financial relationship, unless that relationship falls within certain exceptions. The United States contended that certain relationships between Cox and physicians ran afoul of the Anti-Kickback Statute, which prohibits offering inducements to providers in return for patient referrals, and the Stark statute. Additional claims being resolved concern Cox’s inclusion of non-reimbursable costs on its Medicare cost reports and improper billings for services provided to dialysis patients.
“The Justice Department is committed to ensuring that the best interests of federal health care program patients are not compromised by unlawful payments to physicians,” said Gregory G. Katsas, Assistant Attorney General for the Justice Department’s Civil Division. “The resolution of this matter resulted in a significant recovery for taxpayers, and it exemplifies our dedication to vigorous enforcement of the Stark and Anti-Kickback Statutes.”
As part of the $60 million settlement, Cox has entered into a Corporate Integrity Agreement with the U.S. Department of Health and Human Services (HHS) Office of Inspector General. The Corporate Integrity Agreement contains measures to ensure compliance with Medicare regulations and policies in the future.
“Today’s settlement furthers both our commitment to protecting patients from improper billing practices and the continued ability of Cox to provide quality medical care in Springfield and the Ozarks,” said John F. Wood, U.S. Attorney in Kansas City, Mo. “I am pleased that we were able to resolve this matter without litigation.”
The settlement with Cox was the result of a coordinated effort by the Commercial Litigation Branch of the Justice Department’s Civil Division; the U.S. Attorney’s Office for the Western District of Missouri; HHS’ Office of Inspector General, Office of Counsel to the Inspector General, and Office of Audit Services; and the FBI.
Source: DoJ
And they are allowed to still OPERATE and BILL MEDICARE/MEDICAID!!!
As part of the $60 million settlement, Cox has entered into a Corporate Integrity Agreement with the U.S. Department of Health and Human Services (HHS) Office of Inspector General. The Corporate Integrity Agreement contains measures to ensure compliance with Medicare regulations and policies in the future.
Missouri Health Care System to Pay U.S. $60 Million to Settle False Claims Act Allegations
July 23, 2008
Lester E. Cox Medical Centers, a health care system headquartered in Springfield, Mo., has agreed to pay the United States to settle claims that it violated the False Claims Act, the Anti-Kickback Statute and the Stark Statute between 1996 and 2005, by entering into certain financial relationships with referring doctors at a local physician group and engaging in improper billing practices with respect to Medicare. Cox, a not-for-profit healthcare organization, will pay the United States $60 million to resolve these claims.
Under the Stark Statute, Medicare providers like Cox are prohibited from billing the federal health care program for referrals from doctors with whom the providers have a financial relationship, unless that relationship falls within certain exceptions. The United States contended that certain relationships between Cox and physicians ran afoul of the Anti-Kickback Statute, which prohibits offering inducements to providers in return for patient referrals, and the Stark statute. Additional claims being resolved concern Cox’s inclusion of non-reimbursable costs on its Medicare cost reports and improper billings for services provided to dialysis patients.
“The Justice Department is committed to ensuring that the best interests of federal health care program patients are not compromised by unlawful payments to physicians,” said Gregory G. Katsas, Assistant Attorney General for the Justice Department’s Civil Division. “The resolution of this matter resulted in a significant recovery for taxpayers, and it exemplifies our dedication to vigorous enforcement of the Stark and Anti-Kickback Statutes.”
As part of the $60 million settlement, Cox has entered into a Corporate Integrity Agreement with the U.S. Department of Health and Human Services (HHS) Office of Inspector General. The Corporate Integrity Agreement contains measures to ensure compliance with Medicare regulations and policies in the future.
“Today’s settlement furthers both our commitment to protecting patients from improper billing practices and the continued ability of Cox to provide quality medical care in Springfield and the Ozarks,” said John F. Wood, U.S. Attorney in Kansas City, Mo. “I am pleased that we were able to resolve this matter without litigation.”
The settlement with Cox was the result of a coordinated effort by the Commercial Litigation Branch of the Justice Department’s Civil Division; the U.S. Attorney’s Office for the Western District of Missouri; HHS’ Office of Inspector General, Office of Counsel to the Inspector General, and Office of Audit Services; and the FBI.
Source: DoJ
Monday, July 21, 2008
James K. Happ
JULY 16, 2008 11:43AM
Healthcare co. exec sells in Palm Beach Gardens
by C.J. Marks, BlockShopper Staff
42 Bermuda Lake Dr.James K. Happ and his wife, Julie, sold a home at 42 Bermuda Lake Drive in Palm Beach Gardens to Charles and Andrea Hirsch for $789,000 on June 23.
The Happs paid $590,000 for the property in Sept. 2003.
Mr. Happ, a certified public accountant, has served as president of Med Diversified, Inc., a provider of home healthcare services based in Andover, Mass. He was named to the position in 2002.
Before he joined Med Diversified, he served as executive vice president of National Century Financial Enterprises, a healthcare financing company and major lender of Med Diversified. He has also served as chief financial officer of Dallas-based Columbia Homecare Group, Inc.
He earned a B.S. in business administration from Miami University in Oxford, Ohio. He holds an M.B.A. from Nova University in Ft. Lauderdale.
The Haps bought a home at 112 Via Escobar Place in Palm Beach Gardens for $540,000 on June 24.
Home sales in Palm beach Gardens dropped nearly 14 percent in 2008 versus sales in 2007. The median sales price also fell from $320,000 to $290,000.
Address: 42 Bermuda Lake Drive
Buyer(s): Charles J Hirsch and Andrea F Hirsch
Seller(s): James K Happ and Julie K Happ
Sale date: 2008-06-23
Healthcare co. exec sells in Palm Beach Gardens
by C.J. Marks, BlockShopper Staff
42 Bermuda Lake Dr.James K. Happ and his wife, Julie, sold a home at 42 Bermuda Lake Drive in Palm Beach Gardens to Charles and Andrea Hirsch for $789,000 on June 23.
The Happs paid $590,000 for the property in Sept. 2003.
Mr. Happ, a certified public accountant, has served as president of Med Diversified, Inc., a provider of home healthcare services based in Andover, Mass. He was named to the position in 2002.
Before he joined Med Diversified, he served as executive vice president of National Century Financial Enterprises, a healthcare financing company and major lender of Med Diversified. He has also served as chief financial officer of Dallas-based Columbia Homecare Group, Inc.
He earned a B.S. in business administration from Miami University in Oxford, Ohio. He holds an M.B.A. from Nova University in Ft. Lauderdale.
The Haps bought a home at 112 Via Escobar Place in Palm Beach Gardens for $540,000 on June 24.
Home sales in Palm beach Gardens dropped nearly 14 percent in 2008 versus sales in 2007. The median sales price also fell from $320,000 to $290,000.
Address: 42 Bermuda Lake Drive
Buyer(s): Charles J Hirsch and Andrea F Hirsch
Seller(s): James K Happ and Julie K Happ
Sale date: 2008-06-23
The largest prosecution of a home-health-care agency in Virginia
OK!!
GET THIS!!
Nurse pleads guilty to Medicaid fraud
Zavelsky admitted she defrauded Medicaid by submitting false claims for payment.
Total billings for Renaissance to Virginia Medicaid totaled more than $14 million
Zavelsky is facing a maximum of 10 years in prison and a $250,000 fine. Renaissance faces a fine of up to $500,000.
($500,000.+$250,000 = $750,000) Where is the MONEY? $14 MILLION in Billing (remember, we are reading about THIEVES and very Cunning People.)
Hmm.....$14MILLION minus $750,000 = GOOD WORK FOR HOW MNAY YEARS IN PRISON?
TEN? I doubt it. Will be very interesting to see how many years for this PROFIT!
As part of the plea agreement, Zavelsky's husband, Ilya Zavelsky, 46, a physician, was dismissed from the case. The couple live in Glen Allen, and their company provided respite care and other services to Russian-speaking communities in Virginia
Nurse pleads guilty to Medicaid fraud
Billings exceeded $14 million; husband dismissed from case
Saturday, Jul 19, 2008 - 12:08 AM
TIMES-DISPATCH STAFF WRITER
The largest prosecution of a home-health-care agency in Virginia ended in guilty pleas yesterday in federal court.
Rina Zavelsky, 40, a nurse, and her company, Renaissance Inc., pleaded guilty to one count of conspiracy to commit health-care fraud before U.S. District Judge Richard L. Williams.
They will be sentenced Oct. 24. Zavelsky is facing a maximum of 10 years in prison and a $250,000 fine. Renaissance faces a fine of up to $500,000.
As part of the plea agreement, Zavelsky's husband, Ilya Zavelsky, 46, a physician, was dismissed from the case. The couple live in Glen Allen, and their company provided respite care and other services to Russian-speaking communities in Virginia.
They were indicted this year for conspiracy to commit health-care fraud and money laundering. In pleading guilty yesterday, Zavelsky admitted she defrauded Medicaid by submitting false claims for payment.
She acknowledged providing services through unqualified and untrained personal care aides and making false training certificates to cover up the lack of training. The Virginia Department of Medical Assistance discovered the violations in 2003 and 2007.
From 2002 to its closing in 2008, Renaissance employed more than 350 aides acting as independent contractors and made billings for more than 250 Medicaid recipients in the Richmond, Tidewater, Harrisonburg and Northern Virginia areas.
Total billings for Renaissance to Virginia Medicaid totaled more than $14 million.
The case was investigated by the FBI, the U.S. Internal Revenue Service and the Virginia Attorney General's Office.
Virginia Attorney General Bob McDonnell said, "This is an important step forward in ensuring the future of the Medicaid system in the commonwealth."
Chuck Rosenberg, the U.S. attorney for the Eastern District of Virginia, lauded the close work of state and federal agencies in investigating the case. It was prosecuted by Brian Whisler, an assistant U.S. attorney, and Assistant Virginia Attorneys General Dale Mullen and Eric Atkinson.
Contact Frank Green at (804) 649-6340 or fgreen@timesdispatch.com.
GET THIS!!
Nurse pleads guilty to Medicaid fraud
Zavelsky admitted she defrauded Medicaid by submitting false claims for payment.
Total billings for Renaissance to Virginia Medicaid totaled more than $14 million
Zavelsky is facing a maximum of 10 years in prison and a $250,000 fine. Renaissance faces a fine of up to $500,000.
($500,000.+$250,000 = $750,000) Where is the MONEY? $14 MILLION in Billing (remember, we are reading about THIEVES and very Cunning People.)
Hmm.....$14MILLION minus $750,000 = GOOD WORK FOR HOW MNAY YEARS IN PRISON?
TEN? I doubt it. Will be very interesting to see how many years for this PROFIT!
As part of the plea agreement, Zavelsky's husband, Ilya Zavelsky, 46, a physician, was dismissed from the case. The couple live in Glen Allen, and their company provided respite care and other services to Russian-speaking communities in Virginia
Nurse pleads guilty to Medicaid fraud
Billings exceeded $14 million; husband dismissed from case
Saturday, Jul 19, 2008 - 12:08 AM
TIMES-DISPATCH STAFF WRITER
The largest prosecution of a home-health-care agency in Virginia ended in guilty pleas yesterday in federal court.
Rina Zavelsky, 40, a nurse, and her company, Renaissance Inc., pleaded guilty to one count of conspiracy to commit health-care fraud before U.S. District Judge Richard L. Williams.
They will be sentenced Oct. 24. Zavelsky is facing a maximum of 10 years in prison and a $250,000 fine. Renaissance faces a fine of up to $500,000.
As part of the plea agreement, Zavelsky's husband, Ilya Zavelsky, 46, a physician, was dismissed from the case. The couple live in Glen Allen, and their company provided respite care and other services to Russian-speaking communities in Virginia.
They were indicted this year for conspiracy to commit health-care fraud and money laundering. In pleading guilty yesterday, Zavelsky admitted she defrauded Medicaid by submitting false claims for payment.
She acknowledged providing services through unqualified and untrained personal care aides and making false training certificates to cover up the lack of training. The Virginia Department of Medical Assistance discovered the violations in 2003 and 2007.
From 2002 to its closing in 2008, Renaissance employed more than 350 aides acting as independent contractors and made billings for more than 250 Medicaid recipients in the Richmond, Tidewater, Harrisonburg and Northern Virginia areas.
Total billings for Renaissance to Virginia Medicaid totaled more than $14 million.
The case was investigated by the FBI, the U.S. Internal Revenue Service and the Virginia Attorney General's Office.
Virginia Attorney General Bob McDonnell said, "This is an important step forward in ensuring the future of the Medicaid system in the commonwealth."
Chuck Rosenberg, the U.S. attorney for the Eastern District of Virginia, lauded the close work of state and federal agencies in investigating the case. It was prosecuted by Brian Whisler, an assistant U.S. attorney, and Assistant Virginia Attorneys General Dale Mullen and Eric Atkinson.
Contact Frank Green at (804) 649-6340 or fgreen@timesdispatch.com.
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