One recent criminal Medicare fraud case shows the links between identity theft, patient recruiting and illegal kickbacks. These issues do not affect most health care providers but it is important to understand what is happening in the criminal fraud cases to see why the government is pursuing all "fraud" cases with a vengeance. There is outright fraud like this case here. There are also "fraud" cases where there are simply violations of rules and regulations but where services are provided and medically necessary.
On Jule 30, 2009, after a 7-day trial , a federal jury in Los Angeles found physician assistant, Ronald Luis Bradshaw, guilty on all charged counts, including conspiracy to commit health care fraud, multiple counts of health fraud and aggravated identity theft for prescribing medically unnecessary durable medical equipment to hundreds of Medicare beneficiaries under the stolen identity of a doctor. The loss alleged was $7.7 million. There were two related guilty pleas in this case by a patient recruiter/capper and an owner of a medical equipment company.
According to the evidence presented at trial, Mr. Bradshaw worked as a licensed physician assistant at a Los Angeles clinic, Glenmountain Medical Group (Glenmountain). Under physician assistant rules, Mr. Bradshaw was supposed to be working under the supervision of a doctor. It was alleged in the trial that the doctor supervision was a sham.
The doctor, whose unique physician identification number (called a UPIN) had been used by Mr. Bradshaw to forge medically unnecessary prescriptions, testified that he never worked at Glenmountain and that he never authorized Mr. Bradshaw to use his number. The total amount billed under this doctor’s name for medical equipment and tests prescribed by Mr. Bradshaw was $7,708,069.
Evidence at trial established that from approximately April 2005 to April 2008, Mr. Bradshaw prescribed hundreds of motorized wheelchairs and custom-fitted orthotics to Medicare beneficiaries under the apparent authority and supervision of this same doctor. Mr. Bradshaw also ordered diagnostic tests for these beneficiaries under the same doctor’s apparent authority.
Several beneficiaries (patients) testified at trial that they were recruited by patient recruiters to be examined at Glenmountain. Some beneficiaries testified that they were enticed by the promise of a free exam, while others were promised free, expensive medical equipment.
Juana Aranda, a professional patient recruiter/capper who previously pleaded guilty in connection with this case, testified that she was paid cash for bringing Medicare beneficiaries to Glenmountain and that she was paid more if the beneficiary was prescribed a motorized wheelchair.
Each of the beneficiaries who testified at trial stated that they had no difficulties walking and that they did not complain about any difficulties during their respective examinations. After their examinations, however, each received a motorized wheelchair delivered to them by Star Medical Supply Inc., a durable medical equipment company owned and operated by Karen Arakelyan, who previously pleaded guilty in connection with the facts in this case.
Mr. Arakelyan testified that he paid a Glenmountain representative $1,200 per prescription. Mr. Arakelyan admitted he then delivered a motorized wheelchair to the beneficiary and filed a fraudulent claim with Medicare based on the bogus prescription that he purchased from Glenmountain.
At sentencing, scheduled for November 12, 2009, Mr. Bradshaw faces a maximum penalty of 10 years in prison on each of the four health care fraud counts as well as the conspiracy to commit health care fraud count for which he was convicted. In addition, he faces a mandatory two-year prison sentence on the aggravated identity theft count, which must be served consecutive to the sentence on the fraud counts. In determining the actual sentence, the federal judge will consult the advisory U.S. Sentencing Guidelines, which provide appropriate sentencing ranges that take into account the severity and characteristics of the offense, the defendant's criminal history, if any, and other factors. The judge, however, is not bound by those guidelines in determining a sentence.
Posted by Tracy Green, Esq. Please email Ms. Green at tgreen@greenassoc.com or call her at 213-233-2260 to schedule a complimentary 30-minute consultation. Ms. Green's office at Green and Associates is located in Los Angeles, California.
Any questions or comments should be directed to Tracy Green, a very experienced California health care fraud attorney, Los Angeles physician assistant attorney, and Los Angeles health care attorney at tgreen@greenassoc.com. The firm focuses its practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing licensed health care providers including physician assistants. Their website is: http://www.greenassoc.com/
