Years ago, health care fraud cases would generally only be brought for outright fraud where there was ghost billing for patients not seen or other type of fraud. However, upcoded billing is now being charged more often when there is a significant pattern. A recent case involving a podiatrist illustrates this.
On May 17, 2019, podiatrist Loren Wessel of Tucson, Arizona was
sentenced by U.S. District Judge James Soto for his role in a
Medicare fraud scheme to serving a 24-month term of imprisonment. Mr. Wessel had previously pleaded guilty to Health Care
Fraud. The Court also ordered Wessel to pay $965,985 in restitution to the Centers for Medicare and Medicaid Services.
In the plea agreement, Mr. Wessel admitted that from 2008 through June 2016 that he as a licensed podiatrist defrauded Medicare out of hundreds of thousands of dollars. In his plea
agreement, Mr. Wessel admitted he submitted false claims to Medicare. As part of
his practice, Mr. Wessel conceded that he regularly provided routine podiatry care for patients at
assisted living facilities in and around Tucson, but fraudulently billed
Medicare for more complex and significantly more expensive services that he had
not performed. To further this upcoding, Mr. Wessel admitted that he falsely
documented patients’ medical records with alleged ailments they did not have
and with care Mr. Wessel did not provide.
Posted by Tracy Green, Esq.
