On June 21, 2013, an owner and chief
executive officer of a comprehensive outpatient rehabilitation facility (CORF) pleaded
guilty to mail fraud for submitting claims to Medicare for services that were
not prescribed by treating doctors. This case had been pending for over two
years since the Indictment was filed in March 2011.
This case involves Medicare billings by Fountain
Valley Healthcare Center (FVHC), a CORF that Tuan Duc Tran owned and operated since 2001. Mr. Tran admitted that he submitted bills to Medicare based on false
claims that Medicare beneficiaries had been referred to FVHC by a physician for
physical and respiratory therapy. Mr. Tran admitted that the names of the
referring physicians were falsely identified. In order for medical necessity to
exist, the patients must be referred by a treating physician and these claims
for payment violated Medicare rules because the treating doctors had not referred
the beneficiaries for rehabilitation.
Under the plea agreement, Mr. Tran will be
required to pay $777,291 in restitution to Medicare. Even though the services
were provided, the entire amount collected is to be treated as a loss amount
and required to be repaid as restitution.
Attorney Commentary: These health care fraud cases are often difficult for those charged to understand where the services have been provided and were even of benefit to the patients. In this case, part of the government's offer of proof was that Mr. Tran had agreed to be familiar with the Medicare rules and regulations and to comply with them. In his case, the fact that the physician names listed on the superbills were not the patients' referring physicians was one of the facts that shifted this case from a billing error case to a fraud case.
Posted by Tracy Green, an attorney specializing in representing and defending health care professionals in health care fraud, Medicare fraud and Medi-Cal fraud allegations, audits, investigations and charges. Email: tgreen@greenassoc.com Office: 213-233-2260
