Sunday, February 15, 2009

Medicare Fraud - Consultant CPA To Skilled Nursing Facilities Sentenced In Federal Court

The prosecution of health care fraud is now extending to the consultants, accountants, and attorneys who advise health care companies. One recent case shows what can happen to Medicare consultants and how they will be held responsible for false billing or reporting.

On February 4, 2009, in the Northern District of Alabama, a CPA (William Lloyd King) was sentenced for conspiracy to commit health care fraud. Mr. King was sentenced to serve 24 months in prison and 2 years supervised release. Mr. King’s wife, Marie Weller King, was previously sentenced to serve 18 months in prison for her role. At that time, the Kings paid $600,000.00 in restitution to the Medicare Program.

The background of the case is as follows. Medicare guidelines state that only payments made to physicians for their services on utilization review (“UR”) committees are allowable as costs on a cost report for a skilled nursing facility. Accordingly, only payments made to physicians for their services on UR committees are allowable as costs. Non-physician compensation associated with UR services are allowable only as part of the administrative costs of the skilled nursing facility and must be allocated as such.

Mr. King, a certified public accountant was involved with King & Associates, Inc., a business which provided consulting services to skilled nursing facilities in Alabama and other states. From approximately January 2002 until approximately December 2006, King, through his own accounting firm, Southern Care, Inc., caused skilled nursing facilities to submit cost reports to Medicare fiscal intermediaries which contained false information regarding the UR services. King also provided false and misleading information regarding UR services to Medicare fiscal intermediaries.

This matter was brought to the attention of the United States through the filing of a qui tam complaint. In April 2008, the United States intervened in that civil action which is currently pending in the United States District Court for Northern District of Alabama and designated as Case Number CV 06-P-4645-S.

The U.S. Attorney for Alabama was quoted as stating:“Professionals who participate in defrauding health care programs place additional burdens and costs on the health care system.” Melody Jackson, Special Agent in Charge for the Atlanta Region, Office of Inspector General further stated: "This case should make it perfectly clear that the OIG will actively investigate and prosecute not only crooked healthcare professionals and companies, but also those consultants who too often are responsible for Medicare fraud."

Any questions or comments should be directed to: Tracy Green is a principal at Green and Associates in Los Angeles, California. They focus their practice on the representation of individuals, businesses, licensed professionals and providers, with an emphasis on health care professionals.


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