Federal prosecutors have said that two owners of psychological service companies have been convicted of an $8.9 million fraud scheme that billed Medicare for unnecessary or nonexistent tests on nursing home patients in four Gulf Coast states.
The owners, a Slidell, Louisiana man and his 63-year-old mother, plan to appeal, according to reports.
Each owned companies in Louisiana, Mississippi, Alabama and Florida.
A jury convicted them Tuesday of conspiracy to commit health care fraud and of conspiracy to make false statements about health care. According to reports, the jurors also found them responsible for $8.9 million in fraudulent payments.
Two psychologists who worked for them pleaded guilty last year, admitting $5.6 million in fraudulent claims.
Medicare fraud is rampant across the United States. Medicare fraud prosecutions are highly specific and headed by the U.S. Attorney’s Health Care Fraud Division. With that said, defense of Medicare fraud allegations requires an attorney that understands billing practices, compliance issues, and medical necessity.
Some examples of medicare fraud include:
- Submitting false claims
- Billing for services or supplies not provided
- Billing for medical equipment not prescribed by doctors
- Submitting claims for services or supplies for a patient who does not exist or who the provider has no physician-patient relationship
- Up-Coding or billing a higher code than the service actually performed
- Performing additional treatments or tests which are not clinically necessary
- Duplicate billing