Monday, June 16, 2014

Los Angeles Doctor Charged With Medicare Fraud For Signing Home Health And Hospice Certifications That Were Not Medically Necessary - OIG Investigations Continue

We can expect to see more health care fraud cases involving home health, hospice, physical therapy and occupational therapy being filed in California. These cases also usually involve marketing of Medicare beneficiaries. The Office of Inspector General (OIG) is investigating old cases and seeking to file them even where the billing was done years ago. A recent case involved billing back from 2006.

On June 3, 2014, an Indictment was filed against Dr. Robert Glazer alleging conspiracy to commit health care fraud in violation of 18 U.S.C. §1349, health care fraud in violation of 18 U.S.C. §1347, and aiding and abetting health care fraud from January 2006 to May 2014.  Dr. Glazer is presumed innocent and these are simply allegations in the Indictment. It is alleged that all these certifications for home health, PT and OT and the DME prescriptions resulted in billings to Medicare totaling $33 million which resulted in payments of $22 million. Does this mean that Dr. Glazer received $22 million? Of course not, but in a conspiracy he is liable for the certifications he wrote them and there was not medical necessity.

The Indictment though will show what I see in many health care fraud cases in the Los Angeles area.  First, the doctor allegedly used his clinic to provide medically unnecessary certifications for (1) home health services for nursing, physical therapy and occupational therapy, (2) hospice services, and (3) durable medical equipment for power wheelchairs. 

Medicare coverage for hospice is limited to situations where it has been medically certified that beneficiaries are terminally ill, have 6 months or less to live, and the beneficiary chose hospice understanding that Medicare will not cover treatment intended to cure the beneficiaries' terminal illnesses.

Second, this case involves the marketing of Medicare beneficiaries. A marketer is alleged to be a co-conspirator who recruited Medicare patients for the home health agency and the medical clinic. Patients allegedly received free diabetic shoes and promises of free power wheelchairs. There is a lot of marketing in hospices and the fees paid to marketers are significant. With marketing, any claim will be a false claim but this case goes beyond pure marketing and kickback issues.

Third, this case involved a manager or hidden owner of the Medicare clinic. The Indictment alleges an owner of home health services (Fifth Avenue Home Health) was a manager alleges that the medical clinic provided unnecessary services. In many of these cases, managers and hidden owners are involved.

These fraud cases take years to find their way to court. For physicians who wrote certifications, they are now being held responsible for the billings of third party home health agencies, hospices and DME companies. In some of these cases, the DME companies have been prosecuted and now the government is coming back to charge the physicians, especially now that the individuals who have plead guilty or been convicted are cooperating.

OIG Investigations. If the Office of Inspector General (OIG) has come to your office and requested files by subpoena or request, there is a pending criminal investigation. I have seen many providers not take these subpoenas or investigations seriously and let themselves and their staff interviewed. After a year or two, medical providers may think that these cases have gone away but then find that the investigations are still ongoing. 

It is important to seek expert advice early on in these cases in order to evaluate the legal issues. In some cases, where there is a good defense it may be critical to hire an expert early and present this evidence to OIG or the U.S. Attorney's Office in order to prevent cases from being filed. In other cases, there may be reasons to not disclose this information or evidence and wait to see whether or not charges will be filed. There are many other ways to proceed since each case is different. It is important to have knowledge and understand the allegations, the billing issues and why there is an investigation. This also allows medical providers to plan ahead. 

Posted by Tracy Green, Esq.
Green and Associates, Attorneys at Law
800 West 6th Street, Suite 450
Los Angeles, California 90017
Tel: 213-233-2260


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