Tuesday, April 12, 2016

New Jersey Family Doctor Who Billed For Non-Existent Office Visits, Altered Patient Medical Records Sentenced To More Than Three Years In Prison

In the past, if there were Medicare audits for services billed but not performed, there would be a demand for overpayment and criminal prosecutions were rare. This is changing.  One recent case shows what can occur with billing for services not provided.

On March 15, 2016, a New Jersey family physician, Dr. Albert Ades, was sentenced to 37 months in prison for defrauding Medicare, Medicaid and private insurance companies out $280,000 by billing them for non-existent office visits after pleading guilty to Count One of a federal indictment charging him with health care fraud

According to the documents filed and statements made in court: From 2005 through June 2014, Dr. Ades, a licensed family medicine doctor fraudulently billed Medicare, Medicaid and various private payors for face-to-face physician office visits that never happened. Dr. Ades admitted to writing prescriptions, authorizing refills or performing other tasks without ever seeing those patients on the billed dates. 

Dr. Ades admitted that he altered patients’ medical charts by inserting fabricated blood pressure readings, other vitals and clinical notes on patients’ charts to make it appear as if they had visited Dr. Ades’s office on the billed dates.  

Dr. Ades admitted that, between 2009 and 2013, he caused a loss of approximately $280,000 to federal health care benefit programs and private insurers.  In addition to the prison term, Judge Salas sentenced Ades to three years of supervised release and ordered him to forfeit $280,000.

In the past, cases would not be prosecuted unless there were larger amounts at issue. This case as well as many others show that the threshold has changed for charging.

Posted by Tracy Green, Esq.


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