Another Infamous Example of Healthcare Fraud in Florida
185 بار بازدید -
2 سال پیش
-
The Department of Justice (DOJ)
The Department of Justice (DOJ) estimates that healthcare fraud generates roughly $100 billion a year. Unfortunately, that means this type of crime happens all the time. What’s worse is that these schemes are hard to detect and understand. Oftentimes, perpetrators will commit one type of healthcare fraud to cover up other parts of the greater scheme.
LINKS:
____________________________________________
https://etactics.com/blog/healthcare-...
____________________________________________
December 2022 was a bad month for healthcare fraud in Florida because Ruth Fernandez was also convicted. You see, a judge sentenced Fernandez to three years in prison for her role in the conspiracy to commit healthcare fraud. She was also indicted for making a false statement in a situation involving a federal healthcare benefit program.
What happened that led to a woman spending three years in prison? According to court documents, the fraud happened from January 2018 to April 2019. Fernandez worked under Patsy Truglia’s supervision and direction. Truglia received a previous sentencing of 15 years in prison. Under Truglia’s supervision, Fernandez generated medically unnecessary physician’s orders through a telemarketing operation for certain orthotic devices. Referred to as Durable Medical Equipment (DME), these devices include knee braces, back braces, wrist braces, and other braces.
Through the telemarketing operation, Fernandez harvested personal and medical information to create unnecessary DME brace orders. These were then forwarded to purported “telemedicine” vendors. In exchange for a fee, these vendors paid illegal bribes to physicians to sign the orders. This was all done without ever contacting the beneficiaries to conduct the required telehealth consultations. The illegal brace orders were then returned to Truglia’s telemarketing operation. To avoid Medicare scrutiny Fernandez spread the fraudulent claims across five DME storefronts operated by Truglia’s control and Fernandez’s management. Through the five storefronts, Truglia, Fernandez, and other conspirators caused approximately $25 million in fraudulent DME claims submitted to medicare. This resulted in roughly $12 million in payments.
The judge found Fernandez guilty of fraud. As part of her sentencing, Fernandez has to pay approximately $12 million to the affected government healthcare programs and insurance companies. The courts spread this dollar amount across several co-conspirators involved in the scheme. The court also entered an order of forfeiture in the amount of $62,650 against Fernandez.
Now that the trial’s over and Fernandez received her sentencing, we need to determine the type of healthcare fraud involved in the case. The conspiracy used medical identity theft to fraudulently place orders for the braces. According to the Medical Identity Theft Alliance, more than 2 million Americans were victims of medical identity theft. Medical identity theft involves the misuse of someone’s information to submit claims. In this particular case, people stole information from patients to make fraudulent DME claims. This case also includes phantom billing. The patients were never contacted by the telemarketing scheme. They were never patients where Fernandez worked. Therefore, any claims submitted were for procedures and treatments that never happened. Billing for unnecessary services/items and upcoding are also present in this case. There’s a good chance that the people linked to the stolen information never actually needed the braces. Therefore, the claims for the braces were completely unnecessary.
► Reach out to Etactics @ https://www.etactics.com
►Subscribe: https://rb.gy/pso1fq to learn more tips and tricks in healthcare, health IT, and cybersecurity.
►Find us on LinkedIn: LinkedIn: etactics-inc
►Find us on Facebook: Facebook:
#HIPAA #hipaatraining
LINKS:
____________________________________________
https://etactics.com/blog/healthcare-...
____________________________________________
December 2022 was a bad month for healthcare fraud in Florida because Ruth Fernandez was also convicted. You see, a judge sentenced Fernandez to three years in prison for her role in the conspiracy to commit healthcare fraud. She was also indicted for making a false statement in a situation involving a federal healthcare benefit program.
What happened that led to a woman spending three years in prison? According to court documents, the fraud happened from January 2018 to April 2019. Fernandez worked under Patsy Truglia’s supervision and direction. Truglia received a previous sentencing of 15 years in prison. Under Truglia’s supervision, Fernandez generated medically unnecessary physician’s orders through a telemarketing operation for certain orthotic devices. Referred to as Durable Medical Equipment (DME), these devices include knee braces, back braces, wrist braces, and other braces.
Through the telemarketing operation, Fernandez harvested personal and medical information to create unnecessary DME brace orders. These were then forwarded to purported “telemedicine” vendors. In exchange for a fee, these vendors paid illegal bribes to physicians to sign the orders. This was all done without ever contacting the beneficiaries to conduct the required telehealth consultations. The illegal brace orders were then returned to Truglia’s telemarketing operation. To avoid Medicare scrutiny Fernandez spread the fraudulent claims across five DME storefronts operated by Truglia’s control and Fernandez’s management. Through the five storefronts, Truglia, Fernandez, and other conspirators caused approximately $25 million in fraudulent DME claims submitted to medicare. This resulted in roughly $12 million in payments.
The judge found Fernandez guilty of fraud. As part of her sentencing, Fernandez has to pay approximately $12 million to the affected government healthcare programs and insurance companies. The courts spread this dollar amount across several co-conspirators involved in the scheme. The court also entered an order of forfeiture in the amount of $62,650 against Fernandez.
Now that the trial’s over and Fernandez received her sentencing, we need to determine the type of healthcare fraud involved in the case. The conspiracy used medical identity theft to fraudulently place orders for the braces. According to the Medical Identity Theft Alliance, more than 2 million Americans were victims of medical identity theft. Medical identity theft involves the misuse of someone’s information to submit claims. In this particular case, people stole information from patients to make fraudulent DME claims. This case also includes phantom billing. The patients were never contacted by the telemarketing scheme. They were never patients where Fernandez worked. Therefore, any claims submitted were for procedures and treatments that never happened. Billing for unnecessary services/items and upcoding are also present in this case. There’s a good chance that the people linked to the stolen information never actually needed the braces. Therefore, the claims for the braces were completely unnecessary.
► Reach out to Etactics @ https://www.etactics.com
►Subscribe: https://rb.gy/pso1fq to learn more tips and tricks in healthcare, health IT, and cybersecurity.
►Find us on LinkedIn: LinkedIn: etactics-inc
►Find us on Facebook: Facebook:
#HIPAA #hipaatraining
2 سال پیش
در تاریخ 1401/11/20 منتشر شده
است.
185
بـار بازدید شده