Fake it 'till you make it: Fraud enforcement targets the make believe

Prosecutors, investigators and fraud enforcement officials specialized in uncovering the art of fakery this week, targeting schemes that included deceased patients, a nurse imposter, forged prescriptions and falsified time sheets.

On Monday, a McAllen, Texas physician found himself facing new charges for defrauding Medicare, adding to a previous indictment for participating in an illegal kickback scheme, according to an announcement from the U.S. Attorney's Office for the Southern District of Texas. Eduardo Carrillo, M.D., was released on bond in June, but was arrested again last week for attempting to bill Medicare for 34 deceased patients. Carillo is accused of submitting fraudulent documentation to a billing company claiming he provided services to the patients in an attempt to collect Medicare reimbursement.

In 2011, the Centers for Medicare & Medicaid Services reportedly paid $23 million to more than 17,000 Medicare members that were deceased. In June, the the Government Accountability Office testified before Congress that Medicaid had paid $9.6 million for 200 deceased beneficiaries in four different states.

A few hundred miles north, a Dallas hospice nurse was sentenced to four years in prison for stealing the identity of a registered nurse in order work at eight different hospice providers, where she treated 243 patients, according to an announcement from the U.S. Attorney's Office for the Northern District of Texas. Jada Necole Antoine used a stolen registered nurse's license and social security card in order to gain employment at hospice agencies. Those providers submitted claims for patients under her care in which she performed her own patient assessments, leading to approximately $800,000 in false claims.

In February, a Florida woman was sentenced to 17 years for posing as a licensed physician and nurse practitioner, prompting Medicare to pay $8 million in phony prescriptions.

Last week, law enforcement officials in Louisiana and Maryland dealt with fraudsters who submitted fake time sheets and diverted drugs using falsified prescriptions. On Friday, Huntingtown, Maryland physician Peter Wisniewski pleaded guilty to writing prescriptions of Oxycodone and Adderall for three elderly patients, which he diverted for his own use, according to the U.S. Attorney for the District of Maryland. Wisniewski falsified the patients' medical files and told the pharmacy that he was delivering the drugs to the patients himself.

In May, authorities in Florida and Alabama busted drug rings as part of Operation Pillution, a multi-state crackdown on drug diversion. In the past, criminals have indicated that forging prescriptions is easy thanks to lax prescribing laws and limited tracking systems.

On the same day, the Louisiana Attorney General announced Medicaid fraud charges against Natrell Shelton. The personal care nurse was arrested for falsifying time sheets and service logs that showed she was caring for two patients in different locations at the same time. As a result the state paid nearly $3,500 for her services.

For more:
- here's the announcement from the U.S. Attorney's Office for the Southern District of Texas
- read the announcement from the U.S. Attorney's Office for the Northern District of Texas
- see the announcement from the U.S. Attorney's Office for the District of Maryland
- here's the Louisiana Attorney General's announcement

Suggested Articles

The HHS OIG is asking for an additional $23.7 million to support fraud oversight that has benefited from an emphasis on data analytics.

A New York surgeon was sentenced to 13 years in prison for fraud and more physician practice news from around the web.

A federal judge has ruled that the U.S. government’s remaining fraud case against UnitedHealth can move forward.