What is Medicare Fraud?

Medicare fraud occurs when a hospital, nursing home, doctor's office, hospice care facility, ambulance service, pharmacy, rehabilitation center, or any other type of healthcare provider overbills Medicare.


Who can report Medicare fraud?

Medicare fraud whistleblowers are almost always healthcare professionals. They are commonly employed as hospital administrators, nurses, hospice or nursing home workers, ambulance drivers, pharmacists, or as any other type of healthcare professionals.

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Four persons convicted for their involvement in a $4.7 million Medicare fraud scheme
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The US Department of Justice (DOJ), in an August 17, 2011 press release, reported the August 16 conviction of four persons for their involvement in a $4.7 million Medicare fraud scheme.

The announcement by the DOJ, the FBI, the Department of Health and Human Services (DHHS) and the Medicaid Fraud Control Unit (MFCU) of the Louisiana Attorney General’s Office identified those involved as a physician, the owner of a Baton Rouge durable medical equipment (DME) company and two patient recruiters.

At the conclusion of a two-week trial, the four, Dr. Sofjan Lamid, NNanta Felix Ngari, Henry Lamont Jones and Ernest Payne were each found guilty by a federal grand jury of one count of conspiracy to commit health care fraud and one count of conspiracy to defraud the US government and to pay and receive illegal health care kickbacks.

Ngari owned and operated Unique Medical Solution Inc, a Baton Rouge-area supplier of DME. He specialized in providing Medicare patients with powered wheelchairs.

Trial evidence showed that Ngari began paying recruiters, including Payne and Jones, in late 2003 to find and solicit Medicare beneficiaries to attend so-called health fairs hosted by the two at local churches and other locations.

The scheme worked like this: Doctors at the health fair, including Dr. Lamid, prescribed the wheelchairs to Medicare beneficiaries even though they were medically unnecessary. Ngari then provided the wheelchairs based on these prescriptions and submitted claims under his company name.

Recruiters Payne and Jones reimbursed the doctors with illegal kickbacks based on the number of prescriptions they wrote. The recruiters were, in turn, paid by Ngari on the same basis.

From 2003 to 2009, Unique submitted $4.7 million of the fraudulent claims and received payments of about $2.5 million on these claims.

Although a sentencing date has not been scheduled, if convicted on both conspiracy counts, the defendants could face up to a maximum of 10 years in prison and a fine up to $250,000.

The Medicare Fraud Strike Force, supervised by DOJ’s Criminal Division Fraud Section and the U.S. Attorney’s Office for the Middle District of Louisiana, brought the case to light and successfully saw it through to trial.

The Medicare Fraud Strike Force runs fraud-fighting operations in nine locations. It has charged more than 1,000 defendants who in total have billed the Medicare program for more than $2.3 billion.


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