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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Healthcare professionals may be entitled to a significant financial reward for becoming Medicare whistleblowers. Learn about receiving a financial reward for your information here.


California durable medical equipment company convicted of Medicare Fraud
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A Los Angeles federal jury convicted owner-operators of a durable medical equipment (DME) company of Medicare fraud. The new was reported in a July 17,2009 US Department of Justice (DOJ) press release.

The owners, Gevork Kartashyan and Eliza Shurabalyan, were found guilty of conspiracy to commit health care fraud and health care fraud. They operated CHH Medical Supply, a DME supply company and will be sentenced on October 5, 2009.

Court records showed that they billed Medicare for $949,859 between January 2005 and June 2008. Of those claims, they were paid $597,750.

Elderly Medicare beneficiaries testified at trial how they were solicited and taken to Los Angeles-area medical clinics. Once there, they routinely shared their personal and Medicare information. Some were induced with promises of vitamins, diabetic shoes and other goods which they never received.

The clinics were a churning factory, harvesting Medicare beneficiary information and writing wheelchair prescriptions which they then sold to DME companies like CHH. Many beneficiaries reported they weren’t aware they were getting a wheelchair until it was delivered by CHH. Every one of the beneficiaries said they did not need nor use the wheelchair.

CHH went so far as to forge doctor’s signatures on phony prescription pads. Five doctors testified they never authorized or approved prescriptions under their name, in many cases by physician’s assistants.

One of the government’s witnesses, a man who recently pleaded guilty to health care fraud in relation to one of the clinics involved in this case, told how Kartashyan would routinely come into the office to pick up power wheelchair prescriptions.

All the Medicare claims were submitted by Shubaralyan who was listed as an owner of CHH. Over 98 percent of the company’s Medicare billings were for power wheelchairs.

Much of the success in these cases must go to the Medicare Fraud Strike Force . The joint DOJ-HHS Force is a multi-agency team of federal, state and local investigators. Their sole intent is to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing.


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