Ladies and Gentlemen,
Let's stand up and give a round of applause to our new friends at the U.S. Department of Health and Human Services Office of Inspector General and the U.S. Department of Justice Attorney General for catching a Medicare Fraudfeasor!
This same, exact scheme is a mirror image of what is done in Medicaid. Instead of the area of physical therapy, you have it in foster care and adoption because children do not sign nor review the documents, and, parents are not privileged to even know what is going on with their own children.
Free reign on fraud, straight-up bilking tax dollars. No accountability, no transparency, no oversight.
Here is a real life example. I know because I talked to the people who were actually doing it, and I have the documents to prove it. And yes, the documents are cyber-filed protected.
In Wayne County, Michigan, there are no bids on state child placing agency (CPA) contracts. These 5 agencies provide services to abused and neglected children. Each year, the big 5 CPAs submit letters of renewal, that include an increase in the contractual fees.
Then, the big 5 submit billing to Wayne County for certain services provided to children. There is no human way possible to verify if the services were actually rendered. It is relatively economically impossible to even go through each and every billing statement to even see if the clients meet eligibility criteria. Here is an example:
In Wayne County foster care, they will use referrals to the Juvenile Assessment Center for adults. Yes, that is correct, adults. The majority of the time the services rendered to these "adults" are only on paper, the same paper that is submitted for billing reimbursements.
Then in Wayne County, you have employment services for children. Yes, employment services for children, where the county will conduct employment background checks to make sure these children are eligible for employment, sometimes 5 days a week. I would reveal who the check was made out to, but I do value my life.
But the fraud in foster care only gets better.
In Wayne County you have what is called the Will Smith/Bill Smith billing system. Basically, a child is taken into foster care and billed as a foster care child. Then, with a cut and a paste of the same Social Security number, Will becomes Bill, who is now a juvenile delinquent. And there you have it, double-billing.
Yes, there is a legitimate form of double-billing called "dual jackets". This is when a child is in one system and needs services from the other but a review of the records will show that the name remains the same.
I will be providing the Medicaid Fraud Strike Force with as much instruction as possible to assist in the detection, identification, and recovery. I want Michigan to be the model state.
I will also be coming out soon with my book to better understand how the industry functions.
Until then, bravissimo H.E.A.T., encore!
Department of Justice Press Release
For Immediate Release
August 26, 2009 United States Attorney's Office
Eastern District of Michigan
Contact: (313) 226-9100
Detroit Area Physical Therapist Pleads Guilty to Causing More Than $1.6 Million in Fraudulent Medicare Billing
Detroit area physical therapist Jay Jha, 45, pleaded guilty today to participating in a conspiracy to defraud the Medicare program of approximately $18.3 million. Jha, of Troy, Mich., pleaded guilty to one count of conspiracy to commit health care fraud before U.S. District Judge Gerald Rosen. At sentencing, scheduled for Dec. 16, 2009, Jha faces a maximum penalty of 10 years in prison and a $250,000 fine.
According to information contained in plea documents, Jha, a physical therapist licensed in the state of Michigan, began working in approximately February 2003 as a contract therapist for a co-conspirator. The co-conspirator owned and controlled several companies operating in the Detroit area that purported to provide physical and occupational therapy services to Medicare beneficiaries. Jha admitted that he, the co-conspirator, and others created fictitious therapy files appearing to document physical and occupational therapy services provided to Medicare beneficiaries, when in fact no such services had been provided. According to court documents, the fictitious services reflected in the files were billed to Medicare through sham Medicare providers controlled by co-conspirators.
In order to create the fictitious therapy files, Jha acknowledged that his co-conspirators paid cash kickbacks and other inducements to Medicare beneficiaries, in exchange for the beneficiaries’ Medicare numbers and signatures on documents falsely indicating that they had received physical or occupational therapy. Jha admitted that he was one of the licensed physical or occupational therapists from whom the co-conspirator obtained signatures on fictitious "progress notes" and other documents in the therapy files, falsely indicating that the therapists had provided therapy services to the Medicare beneficiaries on those dates.
During the course of the scheme, Jha admitted he signed approximately 336 fictitious physical therapy files indicating that he had provided physical therapy services to Medicare beneficiaries, when in fact he had not. Jha admitted that he was paid between $90 and $110 for each file that he falsified. Between approximately February 2003 and December 2005, Jha admitted that he falsified physical therapy files that supported claims to the Medicare program totaling approximately $1,680,000. Medicare actually paid approximately $772,800 on those claims. Jha admitted that, throughout the conspiracy, he was fully aware that Medicare was being billed for physical therapy services that he falsely indicated he had performed.
The case is being prosecuted by Trial Attorneys John K. Neal and Benjamin D. Singer of the Criminal Division’s Fraud Section and by Special Assistant U.S. Attorney Thomas W. Beimers of the Eastern District of Michigan. The FBI and the HHS Office of Inspector General (HHS-OIG) conducted the investigation. The case was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of Michigan.
Since the inception of Strike Force operations in March 2007—Miami (Phase One), Los Angeles (Phase Two), Detroit (Phase Three), and Houston (Phase Four)—the Strike Force has obtained indictments of more than 293 individuals and organizations that collectively have billed the Medicare program for more than $680 million. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
Each of the Strike Force teams across the separate phases are led by a federal prosecutor from the Criminal Division’s Fraud Section or the U.S. Attorney’s Office. Each team has an agent from the FBI and HHS-OIG.
To learn more about the HEAT team, go to: www.stopmedicarefraud.gov
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