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  • Tom Boyd

Granny should go to jail


The investigation of health care fraud has been ongoing for a number of years. The 1996 Operation Restore Trust was the biggest push from the government until then and has been followed by HEAT, ZPIC, and the like.

Some of these cases find the fraudster being convicted for paying Medicare or Medicaid beneficiaries for use of their health program identification number. I find it interesting that in NONE of these cases has the beneficiary been charged with a crime or for taking part in a criminal conspiracy. We can all understand that in some if not many cases the beneficiaries were duped into giving up their ID number but in every case for the last 20+ years?

Senior Medicare Patrols (SMPs) empower and assist Medicare beneficiaries, their families, and caregivers to prevent, detect, and report health care fraud, errors, and abuse through outreach, counseling, and education.  . Seniors and everyone involved with health care (and who isn’t a patient, caregiver, family member, or tax payer) should consider becoming better informed, being a SMP volunteer (no age requirement) and reporting anyone they see engaging in fraud regardless of their age. (If you report a fraudulent scheme affecting Medicare, you may be entitled to a whistleblower reward)

What a message the government would send to the elderly community about not selling or loaning their health program identification number to others if some beneficiaries got charged at least and perhaps convicted of a crime for doing so. It is time to make an example of at least one Granny by sending her to jail. (And no I am not volunteering my wife).

Fla. man sentenced to nine years for $21M Medicare fraud Daniel Suarez, a pharmacy technician from Miami, was sentenced to a nine-year prison term for operating a $21 million Medicare fraud scheme. Suarez, who pleaded guilty, was accused of fraudulently billing the program for unprovided and unnecessary prescription drugs and paying kickbacks to patients and patient recruiters in exchange for Medicare beneficiary information.

Utah prescription drug distributor accused of fraud Randy Crowell, owner of Utah-based Green Valley Medical Distributors, has been indicted on charges including conspiracy to commit health care fraud and conspiracy to violate the Food, Drug and Cosmetics Act. Crowell is accused of reselling $100 million worth of old medications as new, legitimate drugs. Authorities say the drugs were bought from patients.

N.J. resident faces charges in $1M Medicare fraud Seth Rehfuss of Somerset, N.J., was arrested and charged Wednesday on allegations of defrauding over $1 million from the Medicare program. Rehfuss and his co-defendants are accused of using The Good Samaritans of America, a nonprofit agency, to find senior citizens to agree to undergo unnecessary genetic testing, according to federal prosecutors.

Md. couple found guilty of Medicaid fraud, conspiracy Florence Bikundi, owner of Global Health Care Services of the District, and her husband, Michael Bikundi, both from Bowie, Md., were convicted Thursday on charges including health care fraud and conspiracy. A federal jury found the Bikundi’s guilty of operating a fraud scheme that cost D.C. Medicaid about $80 million in improper reimbursements from August 2009 to February 2014. They were also found guilty of paying kickbacks to Medicaid beneficiaries in exchange for billing the program for unprovided services.

Texas resident admits to role in $2.9M Medicare fraud Robert Manning, a resident of Houston, pleaded guilty Thursday to his role in a three-year Medicare fraud and kickback scheme that cost the program $2.9 million. Manning admitted to paying $100 to patient recruiters in exchange for each Medicare beneficiary they brought to the New Life Sleeping & Allergy Disorder Center, which fraudulently billed Medicare for unprovided or unnecessary services.

Miss. clinic operators plead guilty to defrauding Medicare Dennis and Brenda Sensing, a couple from New Albany, Miss., both pleaded guilty Thursday to charges of conspiracy to commit health care fraud and pay illegal kickbacks. The Sensing’s, operators of Guntown, Miss.-based Adult and Children Medical Clinic and salespersons for Jaspan Medical Systems, caused between $400,000 and $1 million in improper Medicare reimbursements, authorities say. The defendants admitted to paying kickbacks to Medicare patient recruiters, falsifying medical records and causing Jaspan to falsely bill Medicare for unnecessary medical equipment.

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