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Thread: Company Fights Back - Examples of Medi-Cal Fraud

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    Liz Mason - is offline Private Investigator Forum Member
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    Company Fights Back - Examples of Medi-Cal Fraud

    Most Medi-Cal providers are honest in their billing practices and provide quality health care to their patients. However, a relatively small number of providers commit fraud directly or become involved in fraudulent schemes. The following are examples of Medi-Cal provider fraud uncovered by CDHS investigators:

    * A "capper" (an individual who recruits and pays patients for insurance fraud schemes) was paid to pick up Medi-Cal beneficiaries in vans and transport them to dental clinics. The dental services were billed to the Denti-Cal program, and people not licensed to practice dentistry performed some of the procedures.

    * An individual who operated a laboratory and several medical clinics billed the Medi-Cal program for blood tests for "ghost" patients who were seemingly referred by a dozen physicians. When interviewed, all of the physicians denied ordering the tests.

    * A person committed identity theft, i.e., used a Medi-Cal provider's identification to set up a fraudulent bank account and apply for new Medi-Cal provider numbers in the provider's name (without the provider's knowledge or authorization). The account was used to launder Medi-Cal warrants obtained using the new provider numbers.

    A task force was established among A&I, the Medi-Cal Fraud Prevention Bureau, and Lab Field Services to conduct preliminary investigations of possible fraudulent activities as well as suspicion of harm to the Medi-Cal beneficiary.

    The objective of this program is to maximize resources to quickly identify fraudulent providers and take appropriate administrative sanctions including suspending potential fraudulent practices expeditiously by placing Withholds and/or Temporary Suspensions on the provider. Since the initiation of the task force, five labs have been temporarily suspended from the Medi-Cal program and 27 labs have been closed.
    This is a case of a company doing what they need to do in order to try and put an end to Medical Frauds.

    Source: www.dhcs.ca.gov/individuals/Pages/StopMedi-CalFraud_Examples.aspx

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    Liz Mason - is offline Private Investigator Forum Member
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    Re: Comapny Fights Back - Examples of Medi-Cal Fraud

    MINNEAPOLIS -- Patrick Daniel Osei, owner of a home health care agency called Advance Home Health, was sentenced Wednesday in Minneapolis Federal Court for defrauding Medicaid and for making false statements to federal investigators.

    United States District Court Judge sentenced Osei, age 51, of Brooklyn Park, to 63 months in prison on one count of illegal remuneration and two counts of making a false statement.

    He was indicted for defrauding Medicaid on Oct. 20, 2009, and charged for making the false statements on May 20, 2010.

    The 63-month sentence was higher than the sentencing range found in the sentencing guidelines, and in pronouncing the sentence, the court emphasized the seriousness of health care fraud schemes, particularly those targeting programs like Medicaid.

    In entering his guilty pleas, Osei admitted that on Nov. 8, 2007, he offered and paid a kickback in the form of cash to someone for referring others to his company, Advance Home Health, in Brooklyn Park. Those referrals were for Personal Care Assistance ("PCA") paid by Medicaid, which provides medical care and services to low-income people who meet certain income and eligibility requirements.

    Medicaid is a federal program administered in Minnesota by the State Department of Human Services.

    In addition, Osei admitted that on April 29 and 30, 2010, he provided false information about assets to federal investigators during the government's attempted recovery of assets connected to the fraud conduct.

    Osei also admittedly engaged in a conspiracy to defraud Medicaid by billing for services not actually provided At the sentencing hearing, the court determined that the total restitution due and owing the Medicaid program because of Osei's criminal activity totaled more than $520,000.

    These cases are the result of investigations by the Federal Bureau of Investigation and the U.S. Department of Health and Human Services-Office of Inspector General.
    www.kare11.com/news/article/906377/14/Medical-company-owner-sentenced-in-fraud-case

    Investigations do work. We all can help put these people out of action.

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