Medicare Fraud on the Rise

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Medicare is a service that offers affordable health care to many of elderly Americans each year, with a similar service called Medicaid offering care for single parents and low income individuals. However, it is also a common target for those that wish to commit fraud. Some news agencies report that fraud among Medicare and Medicaid accounts for a third of their operating budget or as much as sixty billion dollars each year.

While it is possible that these figures are exaggerated by the reporting agency, the point remains that fraud among Medicare and Medicaid is a serious problem. Each month health care providers are charged with Medicare fraud and there are numerous on-going investigations.

One of the most common types of Medicare fraud is billing for services that are not preformed or unneeded. The federal government, who funds Medicare, will typically provide reimbursement for services in only a few weeks, so it is possible to bilk the government out of a good deal of money before being caught. In fact, seldom is a home health care provider caught before millions of dollars have been scammed from Medicare or Medicaid.

Medicaid fraud, which is common as well, is also an attractive target, in part because each state has its own Medicaid Office.

See the Medicaid Website Directory for each states Medicaid website portal.

The reason the number of state by state offices is an attractive target is that even though the actual funding for Medicaid usually comes from the federal government, each state has its own procedures and individual policies. This results in not only more overhead and bureaucracy, which can make it easier to slip through the cracks for an extended period of time, but also means that an agency can target the state with the least strict rules.

While often the actual Medicare patient’s account numbers who are used are completely un-aware that they are involved with a Medicare scam, this is not always the case. In many cases, health care providers and chiropractors will provide a payout or other benefit to those whose account numbers are used.

Those who are involved with Medicare scams are also often of foreign dissent, such as Zafar Mehmood, who has ties to Pakistan and was recently ordered held by federal courts while he awaits trial. However, this is not always the case and a number of well established hospitals and doctors have been involved with Medicare Fraud.

Despite these problems, Medicare and Medicaid both provide an essential service to our country, allowing those who would otherwise not be able to afford care to get the healthcare it needs. With that said, Medicare fraud is quite common and is something that federal agents fight daily. Not only does it provide assistance when obtaining durable medical equipment, such as lift chairs or wheelchairs, these services also provide quality healthcare needs to many seniors.

Those who receive Medicare and Medicaid are often quite thankful for it and even with its problems, it is an important service!

Tampa Bay Man Involved with Medicare Fraud Scheme

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A man named Kesmond L. Wilson from Polk County Florida, which is near Tampa Bay, was recently arrested after an investigation into over seventy false claims to Medicare.

Wilson, who was already on probation, was found hiding in an attic of his grandmother when authorities came to arrest him on charges of probation violation.

Charges of Medicare fraud are expected, as well as an extradition, as Wilson purchased a medical clinic last month using a bad check. Shortly after purchasing the Medical Clinic, which was owned by Dr. Leo Yason, Wilson used the patient records he acquired to submit numerous fraudulent claims to Medicare. In total, there were at least 74 claims submitted

Wilson told Yason that he was part of Wilson Group Billing Claims Health Care Management LLC and sent a check for around $7000 to Yason about a month after purchasing his health care practice.

However, Yason became suspicious when he was contacted by the makers of software used for patient billing. Wilson had contacted the company, asking for an explanation of how to use the software to submit claims to Medicare. Wilson also requested that the company not contact Yason, but this raised red-flags with the software makers, who called to check with Yason.

Yason was still working at the office, which was part of the agreement, but shortly after taking ownership, Wilson changed the locks on the mailboxes. Wilson’s sister is also involved, although she has not formerly been charged and is only wanted for questioning at the present time. She is alleged to have been involved with downloading patients records to her laptop, prior to the sending of the 74 fraudulent Medicare claims.

Wilson is currently being held on bail of over $200,000 and is expected to be extradited shortly on other charges of Medicare fraud, as well as most likely other charges stemming from his purchase of the medical clinic with a bad check and privacy concerns.

12 New Yorkers Charged in Almost $100 Million Medicare Fraud Scheme

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This week, twelve New Yorker’s were charged with Medicare fraud, which investigators contend was responsible for almost $100 million worth of false Medicare claims. Of those, eleven have been arrested as of last week. Those involved were not all related and were made up of three different groups.

Of those arrested, six were part of a group that operated in Flushing, Queens, who were alleged to be responsible for $12 million worth of fraudulent Medicare claims. These individuals, who included one person who was 85 years old, offered a number of treatments to clients, like massages and other spa like treatments. However, they were billed to Medicare as physical therapy sessions. It was also alleged that in exchange for Medicare account numbers, the defendants would provide free lunches and dance classes. They would then use the Medicare numbers when making fraudulent claims.

In Staten Island, one of the defendants, a fifty-six year old osteopathy doctor named Emma Poroger, allegedly billed Medicare for services like sleep studies, vitamin infusion treatment, and other tests, which were never performed. She is accused of around $13 million in Medicare Fraud.

However, the bulk of the Medicare Fraud allegedly came from a group of five individuals from Brooklyn, who attempted to launder around $70 million generated from Fraudulent Medicare claims. They allegedly used Medicare recipient names to bill for services that were never actually performed, offering money to those whose names were used. This same Medical group, Bay Medical Care, had previously been charged with defrauding Medicare to the tune of $72 million back in 2010.

Armenian Man Convicted of Medicare Fraud

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This week, Sardis Tadevosyan was convicted of Medicare Fraud in a federal courtroom in Charlston West Virginia. Tadevosyan, who is a 42 year old man of Armenian decent, was convicted on charges of wire fraud, identify theft, and conspiracy to commit health care fraud.

Tadevosyan, who was the leader of the scheme faces the stiffest penalty, with a possible sentence of as much as 20 years in prison and up to a $250,000 fine. Tadevosyan is expected to be sentenced on January 26, while his co-conspirators are expected to be sentenced on December 01.

The trial, which took 4 days, showed that along with co-conspirators Arsen Bedzhanyan and Igor Shevchuk, a number of fake bank accounts where opened using falsified driver licenses and other information, which included citizens that had left the united states. Each man received $5000 for their efforts.

In all, the scheme is believed to have been responsible for more than four million dollars worth of falsified Medicare Claims. The investigation into this Medicare fraud scheme first began back in April of 2011, with five groups being found to be involved in this scam.

Detroit Man with Ties to Pakistan Ordered Detained in Medicare Fraud

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Zafar Mehmood, a 45 year old man from the Detroit area, was ordered by federal judges to be detained pending the outcome of his current Medicare Fraud Case, which alleges over $30 million in fraudulent claims.

Mehmood is charged with billing Medicare for many unneeded procedures and in many cases procedures that were never actually provided to the patient. In addition he is alleged to have laundered money through several other companies, with much of it ending up in personal accounts and some being taken to Pakistan.

In addition to fraudulent procedures, he is also accused of using kickbacks to people who recruit Medicare patients.

The Federal Judge, Mona Majzoub, decided that Mehmood not only presented a flight risk, but also might potentially try to intimidate witnesses, so ordered Mehmood be arrested awaiting the outcome of his criminal case.

Mehmood owned several home health companies, including Access Care Home Care, Inc., On Healing Home Care Inc., All State Home Care Inc., and Patient Care home Care, Inc, which all dealt with home medical equipment and home medical procedures. These, as well as several other locations were searched by Federal Agents after search warrants were issued, as well as taking control of 31 bank accounts and the suspension of Medicare Payments to sixteen different health care providers.

Mehmood, who is alleged to be the leader of the $30 million medicare fraud scheme will face trial, along with a number of other co-conspirators.