Healthcare Fraud

Instructions: Visit the U.S. Dept. of Health and Human Services (HHS) website. The link below will provide actual cases of Healthcare Fraud violations: https://oig.hhs.gov/fraud/enforcement/criminal/ (Links to an external site.) Choose one case and please use the following questions as prompts to discuss in your initial response. Provide the title of your Healthcare Fraud violation, a summary of the violation, and the outcome to include any fines and actions taken by the OIG. Summarize your professional opinion of the violation (please do not state agree or disagree). Have you experienced any Healthcare Fraud violations personally or in your employment? If so, provide a summary of the violation and outcome. Please be sure to validate your opinions and ideas with citations and references in APA format The article is below Two Defendants Plead Guilty to Multi-Million Dollar Medicare Fraud Scheme BOSTON – A Colorado woman and a Florida woman pleaded guilty today in connection with a multi-million dollar Medicare fraud scheme. Jessica Jones, 30, of Louisville Colo., and Elizabeth Putulin, 30, of Coconut Creek, Fla., each pleaded guilty to one count of conspiracy to commit health care fraud. U.S. District Court Senior Judge George A. O’Toole, Jr. scheduled sentencing for May 19, 2021. Jones and Putulin conspired with Juan Camilo Perez Buitrago to submit more than $109 million in false and fraudulent claims for durable medical equipment (DME) such as arm, back, knee and shoulder braces. In October 2020, Perez pleaded guilty to health care fraud and paying kickbacks in connection with a federal health care program and is scheduled to be sentenced on March 4, 2021. Jones and Putulin helped Perez manufacture and submit false and fraudulent Medicare claims by establishing shell companies in more than a dozen different states, including Massachusetts. Perez directed employees, including Jones and Putulin, to list his mother, wife and yacht captain as corporate directors and to use fictitious names when registering the shell companies as DME providers. At Perez’s request, Jones and Putulin purchased Medicare patient data from foreign and domestic call centers that targeted elderly patients, and instructed call centers to contact the Medicare beneficiaries with an offer of ankle, arm, back, knee and/or shoulder braces “at little to no cost.”  Perez then submitted Medicare claims for those patients without obtaining a prescriber’s order to ensure that the braces were medically necessary. It is further alleged that he submitted blatantly fraudulent claims, including claims for deceased patients and repeat claims for the same patient and the same DME. Perez failed to provide any DME for more than $7.5 million in claims. When Perez did provide DME to patients, he typically billed insurance policies more than 12 times the average price of the DME that he provided to the patient. Jones and Putulin further facilitated the fraud by answering frequent phone calls from Medicare patients who received DME that they did not request, want or need. Jones and Putulin also responded to insurance companies’ requests for prescriber’s orders and medical records, which they were unable to provide. The charging statute provides for a sentence of up to 10 years in prison, three years of supervised release and a fine of $250,000. Sentences are imposed by a federal district court judge based upon the U.S. Sentencing Guidelines and other statutory factors. United States Attorney Andrew E. Lelling; Johnnie Sharp Jr., Special Agent in Charge of the Federal Bureau of Investigation, Birmingham Field Division; Phillip Coyne, Special Agent in Charge of the Department of Health and Human Services, Office of the Inspector General, Boston Division; and Joseph W. Cronin, Inspector in Charge of the U.S. Postal Inspection Service made the announcement today. Assistant U.S. Attorney Elysa Q. Wan of Lelling’s Health Care Fraud Unit is prosecuting the case. Topic(s): Health Care Fraud Component(s): USAO – Massachusetts

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