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.


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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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Medical Care Company Owner and Recruiter in Louisiana Take a Guilty Plea to Medicare Fraud Plot
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Two Baton Rouge residents have taken a guilty plea to charges of their active role in a Medicare fraud plot that allegedly involved an amount more than $21 million, as stated by the Department of Justice, the FBI, the Department of Health and Human Services and the State Attorneys General Office of Louisiana. Henry Jones who is the owner of the four Medicare equipment companies,  took a guilty plea before James J. Brady, the U.S. Middle Louisiana District Judge to one count of conspiring to commit medical care fraud and one count of conspiring to swindle the U.S. government and perform healthcare kickback transactions. Mary Bessie is one of Henry’s accomplices, and she pleaded guilty before Judge James for charges of medical care fraud. 

In Jones testimony, he admitted that during the period in-between 2004-2009, he operated and owned four companies that were fully licensed to distribute durable medical care equipment to their beneficiaries. He also admitted that he hired personnel who would recruit patients and obtain prescriptions that ordered medically unwarranted medical equipment for the companies. 

Typically, the role of the patient recruiters was to obtain the information of the beneficiaries and convince the beneficiaries main medical care giver or their physician to prescribe power wheelchairs and accessories, orthotic equipment and any other medical care equipment. If at all the physician is reluctant to provide a medically uncalled for prescription for the beneficiary, then the patient recruiter would approach another physician and persuade them to provide a prescription on the basis of cursory examinations performed on the patients. 

After the patient recruiters successfully obtain the prescription, they deliver the prescription to medical care equipment company owner, Jones. Jones then billed the purported accrued charges to Medicare for reimbursement. Jones would then pay the recruiters an illegal kickback fee for every prescription obtained. 

Bessie also admitted that between the years 2004-2009 she received kickbacks for Henry Jones for merely providing the medically pointless prescriptions for the medical care beneficiaries. Just for providing enough prescriptions, Bessie received kickbacks of up to about $82,230 according to the court documents. She was charged with aiding and abetting payment of kickbacks and defrauding Medicare. 

Ever since the inception of the Medical care Fraud Force, operations conducted in nine areas have seen to it that more than 1,160 offenders have been brought to justice for defrauding Medicare.

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