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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Occupational therapist charged with Medicare Fraud
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An August 25, 2011 US Department of Justice (DOJ) press release told of the announcement by the Departments of Justice and Health and Human Services (HHS) of the guilty plea by a Detroit-area occupational therapist for her involvement in a Medicare fraud operation.
The 66 year-old woman, Carol Gant, pleaded guilty to a single charge of conspiracy to commit health care fraud. She will face a maximum 10-year prison sentence and a $250,000 fine when she is sentenced later this year.

Court documents said Gant was an occupational therapist working for Jos Campau Physical Therapy, which “purported to provide both occupational and physical therapy services.

Gant admitted that she was hired by the firm to create and sign occupational therapy files, including patient evaluation forms for beneficiaries whom she never met, evaluated or diagnosed.

She further admitted that she brought on an uncertified occupational therapy assistant whose role was to fabricate and sign notes for occupational therapy patient visits that the assistant purported to, but never performed.

Gant then countersigned those notes and filled out patient discharge papers. Gant, in fact, provided no services to the patients whose files she created and countersigned. She was paid for each patient file that she created.

Gant admitted that from June 2005 to May 2007, she and her Jos Campau co-conspirators were directly responsible for submitting false claims for occupational therapy services that were never delivered to the tune of $897,512.

Strike Force operations were central in this case. Their operations are centered in nine locations across the US. Since their inception in March 2007, they have charged more than 1,000 individuals with falsely billing the Medicare program for more than $2.3 billion.

The Strike force is supported by the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, who are taking steps to increase accountability and decrease the presence of fraudulent providers in America’s health care system.

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