Detroit home health owner pleads guilty to $12.6 million Medicare scam; Illinois woman submits fraudulent bills from jail

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> The owner of two Detroit home health agencies pleaded guilty to a scheme in which he billed Medicare for $12.6 million, joining 10 other co-conspirators who have pleaded guilty or been convicted in relation to the case. Mohammed Sadiq admitted to paying kickbacks to recruiters to obtain Medicare beneficiary information, which he used to submit false claims. Sadiq also forged patient files so that it would appear to a Medicare auditor that the services were necessary. Statement

> Last week, an Illinois woman admitted to submitting false claims to a Medicaid Waiver Program while she was incarcerated. Angela Jones pleaded guilty to one count of healthcare fraud for submitting fraudulent claims through the state-run Home Services Program that provides services to individuals with severe disabilities. Jones billed for personal assistant services even though she was in jail at the time. Statement

> A registered nurse in Chicago was arrested for his connection to a four-year scheme in which he fraudulently collected $5 million from Medicare. James Ademiju, who operated two nursing agencies, paid kickbacks to a marketing company to obtain Medicare beneficiary information. Ademiju used that information to submit claims for unnecessary services for patients who weren't confined to their home between February 2011 and December 2014. In the complaint, two patients described receiving "worthless" and "unnecessary" services from Ademiju's companies. Statement

Health Finance News

> A U.S. Court of Federal Appeals invalidated the proposed Centers for Medicare & Medicaid Services contract with recovery audit contractors (RAC), citing a violation of customary commercial practices. The current contract did not allow RACs to collect contingency fees until the second stage of the hospital appeal process. Article

Health Payer News

> The Department of Health and Human Services announced Monday that the Affordable Care Act provided health insurance coverage to 16.4 million Americans, dropping the uninsured rate from 20.3 percent in 2013 to 13.2 percent in March. In particular, young adults dropped from a 34.1 percent uninsured rate in 2010 to 26.7 percent in 2013. Article

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