MLR

Medicare fraud cases just keep on coming …

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Law enforcement is continuing to crack down on Medicare fraud – and the number of cases seems endless.

handcuffs and stethoscope

A huge arrest in May 2014 – when 90 people were arrested from coast to coast in Medicare schemes that totaled over $260 million – may have just been the tip of the iceberg as IRS investigators continue to unmask fraud on a weekly basis.

Here are some of the latest cases:

  • Another pediatrician in New Jersey was sentenced to prison – for over three years – for his part in a bribery scheme for making test referrals to Biodiagnostic Laboratory Services LLC. In total, 22 physicians and 11 other healthcare workers pleaded guilty in the bribery scheme that resulted in more than $100 million in payments from Medicare and other insurers. In the latest case, Dr. Demetrio Gabriel received bribes of $3,000 a month in cash and $1,500 a month through a restaurant he owned. He was ordered to pay restitution of $75,000.
  • A respiratory therapist who ran a medical equipment company on an Indian reservation in Montana billed Medicaid for the most expensive catheters for low-income patients, while providing considerably less expensive ones – 100,000 of them over an eight-year period. Anna Sue Tope bilked the government out of $1.4 million and was sentenced to a year in prison.
  • A Michigan doctor and her husband received kickbacks for referring patients for unneeded testing, resulting in prison terms for the doctor, her husband and the physical therapist. Dr. Shannon Wiggins received a two-year prison sentence; Chyawan Bansil, the physical therapist who never performed the electrodiagnostic tests referred to him, went to jail for 13 months; and Wiggins’ husband Mohamad Abduljaber, her office manager, got a 42-month prison sentence and was ordered to pay $285,781 in restitution and forfeit $550,000. Abduljaber also signed a false income tax return.
  • A Kansas chiropractor was sentence to five years in prison for aggravated identity theft, healthcare fraud and tax evasion. Jeffrey Fenn submitted false claims to Medicare and other insurers using the names of physicians he had hired at his practice. He was ordered to pay $1.8 million in restitution.
  • A nurse who owned a counseling center in Iowa submitted over 6,000 fraudulent claims to insurers using the names of doctors who did not perform the services. Angela Ellison received more than $700,000 in bogus claims. She was sentenced to a year in prison and ordered to pay $724,359 in restitution.