Home Health

In Ohio, a former owner of a home health agency was sentenced to 97 months in prison and ordered to pay $2.7 million in restitution pursuant to her conviction for her scheme to defraud the Government. The investigation revealed that from October 2001 through May 2003, Medicaid was billed for skilled nursing services that were not rendered as claimed. The woman billed for 14 hours of services per week when actually only 1 hour or less of services was provided per week. During the trial, it was also revealed that the woman instructed employees to falsify nursing notes.

Practitioners

In Washington D.C., a doctor was sentenced to 5 months incarceration and ordered to pay $155,000 in restitution for health care fraud. From October 2001 through March 2003, the doctor submitted claims to Medicare for Reteplase injections that were not given. Reteplase is a drug generally given in a hospital emergency room within the first three hours of a patient experiencing myocardial infarction (commonly referred to as a “heart attack”). The doctor submitted claims for one patient who purportedly had been injected 119 times.

In Illinois, a licensed speech-language pathologist was sentenced to 6 months home detention and ordered to pay $60,000 in restitution for health care fraud. From January 2001 to September 2002, the speech-language pathologist billed the Medicaid program for services that were not provided. The investigation revealed that the woman altered or caused to be altered records to reflect therapy services that were not provided.