6-28-10
Medicare Fraud Scheme Conviction Part of Intensified Effort to Thwart Fraud
Stephanie Yamkovenko
Update: On December 14, 2010, the owner and the vice president of a Detroit-area medical clinic were sentenced to 151 months and 108 months in prison respectively in the $23 million Medicare fraud scheme reported below.
On Tuesday, June 22, the owner and the vice president of a Detroit-area medical clinic were convicted in a $23 million Medicare fraud scheme. Bernice Brown, the owner and operator of Detroit-area Wayne County Therapeutic Inc. and Daniel Smorynski, the vice president, submitted $23.2 million in claims to Medicare for occupational therapy and physical therapy that were never provided to beneficiaries.
The conviction was part of the work of the Medicare Fraud Strike Force, a 3-year-old multiagency team that has obtained indictments in seven districts for more than 585 individuals who falsely billed Medicare for approximately $1.3 billion collectively. The consequences of a Medicare fraud conviction are harsh, with a maximum 10-year sentence and $250,000 fine for each charge. Brown and Smorynski were convicted on a combined 18 counts of Medicare fraud and conspiracy to commit fraud.
Many American Occupational Therapy Association (AOTA) members bill Medicare for the occupational therapy services they provide to beneficiaries, so we urge all members to know and understand the severity of committing fraud and know how to appropriately report suspected fraud when necessary.
At issue for the therapists involved was the falsification of records and providing monetary kickbacks to clients. “Practitioners should never provide or entice clients to receive services that are unnecessary to benefit that individual, regardless of payer. Likewise, documentation of services that were not provided or were unnecessary is an ethical and legal violation. Practitioners should report fraud, waste, and abuse when aware of it,” says Deborah Slater, AOTA’s Ethics Officer. “State licensure acts as well as AOTA’s Occupational Therapy Code of Ethics and Ethics Standards (2010) uphold these principles.”
The federal government spends an estimated $500 billion a year for Medicare program beneficiaries.1 The new health care reform law has many fraud and abuse provisions, and with the strike force’s intensified work of indicting perpetrators, now is the time, more than ever, to recognize the harsh consequences of fraud and learn how to report it.
“Our members are honest, truthful, and committed to providing quality services under the law and ethical principles,” says Christina Metzler, AOTA’s Chief Public Affairs Officer. “We also know there are many difficult situations that practitioners face.”
Metzler urged members to inform themselves fully through AOTA’s resources. “In policy and ethics, we educate members with our resources on legal requirements and provide guidance for challenging ethical situations. You can reach out to AOTA to educate yourself.”
In the current fiscal environment, costs for all services—including therapy—are under scrutiny. Metzler noted policymakers focus on fraud as contributing to the rising cost of health care and are highly attuned to any overutilization or inappropriate billing.
“The elimination of fraud and abuse should be a priority for practitioners and their clients. Practitioners have an ethical and professional responsibility to provide services that provide benefit and above all, prevent harm to their clients,” says Slater.
Stephanie Yamkovenko is AOTA’s staff writer.
AOTA would like to hear our member’s opinions and thoughts on Medicare fraud, waste, and abuse on OT Connections.
References
1. Levinson, D. (2009, June 25). Health care reform: Opportunities to address waste, fraud and abuse. Retrieved June 24, 2010 from http://www.hhs.gov/asl/testify/2009/06/t20090625a.html
