Saturday, February 19, 2011

Using dementia patients to rip off Medicare (to the tune of $83 million)

The recently unsealed indictment shows how easy it is to get rich.  As alleged in the Indictment below, a handful of individuals were able to bill Medicare for over $83 million using dementia patients as a platform to commit Medicare fraud. 

The alleged illegal conduct in the indictment is "unlike anything we've seen before in terms of the nature and size of the scheme," Assistant Attorney General, Lanny Breuer said in a statement yesterday.  Unlike so much Medicare fraud that involves medical equipment and services, this case involves Medicare's Partial Hospitalization program, which gives mental health patients much-needed services in outpatient settings.  The defendants preyed on some of the most vulnerable patients, paying kickbacks to owners and operators of assisted living facilities and halfway houses in exchange for patient referrals.  Bogus mental health therapy sessions were organized where elderly and infirm patients were left in rooms for hours, and received no legitimate or medically necessary therapy.  Some of the patients suffered from Alzheimer's disease or dementia, and did not even know where they were.  Others simply came to make money through kickbacks.

Patient recruiters would find people who needed a place to stay overnight and offer them free temporary housing, cash or other bribes in exchange for agreeing to pose as patients. Some of the defendants were also charged with having "charting parties," where senior managers met regularly to write up fake patient medical charts.

Here is the Indictment:


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