Even though this deals with Medicare, it is a classic example of a healthcare fraud scheme, the same ones found in child welfare.
Detroit-Area Doctor Sentenced to 72 Months in Prison for Medicare Fraud Scheme
Patient Recruiter Sentenced to 40 Months in Prison
WASHINGTON—Dr. Toe Myint was sentenced today in Detroit to 72 months in prison for participating in a conspiracy to defraud the Medicare program, announced the Departments of Justice and Health and Human Services (HHS). A patient recruiter was also sentenced today in Detroit to 40 months in prison for his role in the conspiracy.
No one ever goes to jail for participating in conspiracies to defraud the Medicaid program in foster care.
U.S. District Court Chief Judge Gerald E. Rosen ordered Myint, of Bloomfield Hills, Michigan, to pay more than $3.1 million in restitution, jointly with co-defendants, and to serve two years of supervised release following his prison term. Chief Judge Rosen also ordered Terrence Hicks, a Jackson, Michigan, resident and patient recruiter, to pay more than $4.9 million in restitution, jointly with co-defendants, and to serve three years of supervised release following his prison term.
There can never be a federal case against a state privatized child placing agency as the co-defendants would be the state, acting as a contracted arm of the state. What normally happens is that the state is hit with a reduction in its Federal Medicaid Assistance Percentage.
Myint, 56, was convicted by a Detroit jury on January 22, 2010, of one count of conspiracy to commit health care fraud, following a week-long trial. In the last three months, three Michigan-area doctors have been convicted at trial of separate health care fraud offenses as part of the Medicare Fraud Strike Force operations in Detroit. Hicks, 43, pleaded guilty to one count of conspiracy to commit health care fraud on December 18, 2009.
In most instances, there are no bids for local child placing agencies so it would be detrimental, allegedly, to shut down any of facilities down, yet found to provide the greatest good to the community to continue its current patterns of fraud.
Between approximately October 2006 and March 2007, Myint, Hicks, and their co-conspirators caused more than $4.2 million in false and fraudulent claims to be submitted to the Medicare program for services supposedly provided by Myint at Sacred Hope Center Inc., a purported infusion clinic. Medicare actually paid more than $3.1 million of those claims. Hicks also worked at a second, related infusion clinic, called Xpress Center, Inc., which billed an additional $2.3 million in false and fraudulent claims to Medicare.
In 2004, more than $700 million in false and fraudulent claims had been submitted to Medicaid and Title IV-E programs for services supposedly provided by Michigan child placing agencies, but nobody did anything about it except to keep funding the agencies.
Evidence presented during Myint’s trial established that beginning in approximately October 2006 and continuing until March 2007, Myint routinely prescribed medications for patients at Sacred Hope that they did not need, and that in many cases, were never provided to the patients at all. In fact, the clinic existed for the purpose of causing fictitious claims for injection and infusion therapy services to be billed to Medicare. Myint was the only doctor who worked at Sacred Hope, and the owners of the clinic asked him to prescribe particular drugs to patients because they believed that Medicare would reimburse the medications at a high rate. Evidence at trial showed that Myint agreed to prescribe the medications even though he knew the patients did not need them.
Children in foster care are routinely prescribed antipsychotic medications that they did not need, and that in many cases, were never provided to the children at all. In fact, there are child placing agencies that exist for the purpose of causing fictitious claims for child abuse therapy and preparation for adoption therapy services to be billed to Medicaid. Typically, there is only one doctor who works with the child placing agencies and even residential institutions and the owners would ask for particular drugs, like Seroquel, be given to children to secure higher rates of foster care payments and Medicaid reimbursements. These doctors prescribe the medications even though they know the children do not need them.
According to court documents and evidence presented at trial, Medicare beneficiaries were not referred to Sacred Hope or Xpress Center by their primary care physicians, or for any other legitimate medical purpose, but were recruited by Hicks to come to the clinics in exchange for the payment of cash kickbacks. Hicks recruited the beneficiaries in downtown Detroit and drove them to the suburbs of Southfield and Livonia, Michigan, where the clinics were located. Trial evidence showed that in exchange for the cash kickbacks Hicks paid them, the Medicare beneficiaries visited the clinics and signed documents indicating that they had received the services billed to Medicare...more
According to civil lawsuits and state audits, children were not allowed to stay in the home, but were legally kidnapped and pushed through the foster care system to eventually be adopted. Once adopted, all records of Medicaid fraud are destroyed. Mental health providers are then recruited to generate fraudulent reports to keep the children in foster care for extended lengths of time and in exchange for false court reports to support the decision to terminate parental rights, the mental health providers, the mental health providers received kiddy kickbacks, with the child placing agencies signing documents indicating the services were provided to the children.