Tag: Fraud
Pharmacist sentenced for Medicare, Medicaid fraud
October 25, 2024HME News Staff
LONDON, Ky. – Stephanie Collins, a former pharmacist, has been sentenced to 20 months for her role in a scheme to defraud Medicare and Medicaid by billing for medications that she never dispensed to her customers. According to her plea agreement, Collins operated as a registered pharmacist and operated Stephanie’s Down Home Pharmacy, a retail pharmacy located in Corbin, Ky. The pharmacy sought reimbursement from Medicare and Kentucky Medicaid for drugs and other medical products...
Woman charged with enteral fraud scheme
August 19, 2024HME News Staff
DENVER – Colorado Attorney General Phil Weiser has filed fraud and theft charges against a woman in an alleged Medicaid fraud scheme that cost taxpayers more than $1.2 million in losses. Natasha Sawyer is accused of submitting false claims when she worked as a Medicaid biller for Element Medical Supply, a DME company. An investigation by the Medicaid Fraud Control Unit in the Colorado Department of Law found that from May 2020 to March 2021, Sawyer allegedly submitted false claims for enteral...
OIG: Medicare remains vulnerable to orthotics fraud
May 30, 2024HME News Staff
WASHINGTON – The Office of Inspector General says there are still issues related to CMS’s oversight of off-the-shelf braces, including providers that ordered braces for enrollees for whom there was no history of a treating relationship.
The OIG also found new suppliers located in geographic areas with known Medicare fraud; Medicare paid more than private payers for OTS braces; and suppliers used prohibited solicitation to contact enrollees.
“These issues continue...
In brief: CMS makes advance payments, state AG sues Apria, OIG warns of cath scams
March 13, 2024HME News Staff
WASHINGTON – CMS on March 9 made available Change Healthcare/Optum Payment Disruption (CHOPD) accelerated payments to Part A providers and advance payments to Part B suppliers experiencing claims disruptions.
The payments may be granted in amounts representative of up to 30 of claims payments to eligible providers and suppliers. The average 30-day payment is based on the total claims paid to the provider/supplier between Aug. 1, 2023, and Oct. 31, 2023, divided by three. These payments...
OIG publishes ‘Consumer Alert’ for cath scams
March 11, 2024HME News Staff
WASHINGTON – The Office of Inspector General is alerting the public about a fraud scheme involving urinary catheters. In a “Consumer Alert,” the agency says scammers are targeting Medicare enrollees through phone calls, Internet ads and text messages with offers of free services, medical equipment or gift cards upon confirming their personal information and eligibility for specific Medicare services. Often, the enticement for the individual is that they are “qualified”...
AAHomecare supports detection efforts in wake of cath fraud reports
March 7, 2024HME News Staff
WASHINGTON – AAHomecare has issued a statement affirming its support for the government to implement real-time monitoring of claims to detect potential fraud and abuse in response to news reports of potential Medicare fraud by a handful of intermittent catheter companies.
AAHomecare's statement, which was shared with CMS and Capitol Hill, also reiterates recommendations for federal government initiatives to better monitor DME supplier billing practices and trends, including:
Increased...
Georgia man pleads guilty to $127M fraud scheme
December 21, 2023HME News Staff
NEWARK, N.J. – Nicco Romanowski, of Roswell, Ga., pleaded guilty to conspiracy to violate the federal anti-kickback statute and conspiracy to commit health care fraud. From June 2017 through May 2019, Romanowski participated in a scheme with DME companies, telemedicine companies and doctors to submit false claims to health care benefit programs, including Medicare and Tricare. In total, Romanowski and his conspirators caused the submission of false and fraudulent claims to health care benefit...
Physician charged with receiving more than $13M in fraudulent payments
December 6, 2023HME News Staff
SPOKANE, Wash. – Thomas Andrew Webster, M.D., of Sylvania, Ohio, has been charged by with one count of conspiracy to violate the Anti-Kickback Statue in connection with a fraudulent medical supply scheme that targeted elderly Medicare and TRICARE beneficiaries throughout Washington and in other states. According to charges announced by Vanessa R. Waldref, the United States Attorney for the Eastern District of Washington, between May 2021 and September 2023, “Company A” allegedly...
OIG warns of RPM scam
November 27, 2023HME News Staff
WASHINGTON – The Office of Inspector General has posted a consumer alert about a fraud scheme involving monthly billing for remote patient monitoring. The OIG says unscrupulous companies are signing up Medicare beneficiaries for monitoring using medical devices like scales, glucose monitors, blood pressure cuffs, cardiac rhythm devices and other equipment, regardless of medical necessity. The agency says these companies are signing up bennies for these services in several ways, including phone...
Two plead guilty in brace scheme
November 14, 2023HME News Staff
ATLANTA – Brett Weiner and Valerie Desalvo have pleaded guilty to federal conspiracy charges for their role in buying and selling fake doctors’ orders used to obtain more than $1.5 million in fraudulent payments from Medicare, according to the U.S. Attorney’s Office for the Northern District of Georgia. Weiner and Desalvo owned and operated Laboratory Marketing Services, a business in Boca Raton, Fla., that, among other things, received kickback payments in exchange for patient...