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From Health Law Daily, April 14, 2016

Home health fraud bigger in Texas; convictions in $375M scheme

By Kayla R. Bryant, J.D.

After a six-week long trial, a jury convicted a physician and three home health agency owners for their parts in a large Dallas-based fraud scheme that totaled nearly $375 million. Each party was convicted of one count of conspiracy to commit health fraud, and three perpetrators were convicted of additional counts of health care fraud. The physician has been in custody since his February 2012 arrest, while two other participants had been released on bond.

Conspiracy. The physician owned and operated Medistat Group Associates, P.A. (Medistat), a health care provider association and conspired with home health agency owners to defraud Medicare and Medicaid. The owners recruited beneficiaries to sign up for home health services, sometimes paying residents from a homeless shelter $50 for the recruitment efforts. The parties and some of their nurses falsified medical documents so that the beneficiaries appeared to qualify for home health services, and prepared plans of care. The physician’s staff was instructed to certify these plans as if he or another physician had reviewed the treatment plan. Nurses falsified visit notes, and the physician ordered unnecessary medical services. Medistat approved plans of care for 11,000 different beneficiaries, who were reportedly served by 500 different agencies.

When CMS suspended the physician and his company from receiving reimbursement due to suspected fraud, he directed medical providers to bill under a different company that directed the money back to him. This action resulted in an obstruction of justice conviction. Three other defendants pleaded guilty to conspiracy. Two are serving ten year sentences and were ordered to pay $25 million in restitution, while another is awaiting sentencing. The four most recently convicted perpetrators will be sentenced in the fall.

Companies: Medistat Group Associates, P.A.

MainStory: TopStory NewsStory ReimbursementNews CMSNews BillingNews FraudNews HomeNews PartBNews ProgramIntegrityNews

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