Trio of wins for the Medicare Strike Force

Two fraud convictions and a guilty plea marked a successful week for the Medicare Strike Force, which pulled the plug on scams representing more than $209 million in bogus charges for mental health services and durable medical equipment.     

A Miami federal jury convicted Roger Bergman and Rodolfo Santaya--a physician assistant and a certified nursing assistant--for participating in a Medicare fraud scheme billed out at $200 million, the Department of Justice announced.

Bergman and Santaya worked for American Therapeutic Corporation, a mental healthcare company that supposedly provided partial hospitalization programs. But according to prosecutors, Bergman falsified documentation to make it appear that patients qualified for and received partial hospitalization care when they actually didn't. Santaya received hundreds of thousands of dollars in illegal kickbacks for bringing ineligible beneficiaries to the company.

And in Los Angeles, a federal jury found a durable medical equipment supplier guilty of healthcare fraud stemming from a 10-year scheme that billed Medicare approximately $8.3 million, according to eNews Park Forest.

Olufunke Ibiyemi Fadojutmi, R.N., former owner of Lutemi Medical Supply, paid kickbacks to patient recruiters and doctors for fraudulent equipment prescriptions, the article noted. These included power wheelchairs beneficiaries didn't need.

Power wheelchair abuses have drawn governmental attention, since suppliers can buy motorized chairs for $900 but bill Medicare about $6,000 per item, as FierceHealthPayer: Anti-Fraud reported.            

Another equipment supplier pleaded guilty in Louisiana federal court in a case involving false claims for feeding tube services, The Times-Picayune reported. Irmeh Ebere, operator of Golden Medical Equipment & Supply, faces 10 years behind bars after billing Medicare $800,000 for enteral nutrition-related products.

Enteral nutrition is delivered through a tube surgically inserted into the stomach of patients who can't eat or have illnesses that make swallowing difficult. But beneficiaries in Ebere's case didn't have feeding tubes and neither needed nor qualified for enteral feeding benefits, The Times noted. 

To learn more:
- here's the Justice Department announcement
- read the eNews Park Forest article
- see The Times-Picayune article

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.