Beth Jenkins, 48, who owns several adult day care centers near Detroit, Michigan, has pleaded guilty to five counts of health care fraud and one count of conspiracy to commit health care fraud. The scheme involved $13.2 million in false claims to Medicare over a seven year period.
Jenkins and two alleged co-conspirators owned and operated two adult day care centers — Procare Rehabilitation Inc. and Quality Recreation & Rehabilitation LLC (QRR). The three also owned several nearby adult foster care homes (AFCs) where mentally-disabled Medicare recipients were living. According to the Department of Justice, Jenkins and her co-conspirators transported the mentally-disabled Medicare beneficiaries to Procare and QRR, the adult day care centers, for purported group and individual psychotherapy. The AFC residents’ Medicare information was used to bill Medicare for the therapy sessions. The psychotherapy, however, never took place.
Between 2004 and 2011, Jenkins and her alleged co-conspirators presented Medicare with over 185,000 claims for psychotherapy that never occurred. The false claims totaled over $13.2 million. Medicare paid $4.77 million on the claims.
Jenkins’ sentencing has been set for April 2013. She could receive as much as 60 years in prison and a fine of $1.5 million.
Medicare Fraud Hurts Everyone
When Medicare is billed for treatment that patients never received and taxpayers foot the bill, everyone is hurt. Medicare was designed to benefit the nation’s senior population — not unethical health care providers. Medicare fraud also hurts health care workers who are pressured to take part in a fraudulent scheme or to look the other way. No one, however, should be forced into that position just to keep a job.
Employee Insiders Use False Claims Act to Combat Medicare Fraud
Employees are frequently the ones who discover Medicare fraud and notify the government. Sometimes health care workers are told to perform services they know aren’t needed. Accounting and billing personnel may be instructed to engage in unethical Medicare billing practices. Sometimes patient records are falsified as part of the scheme.
To encourage health care insiders to collaborate with the Justice Department in stopping the fraud, the qui tam provisions of the False Claims Act allow an informant to file suit on behalf of the U.S. government and keep a share of any money received.
Before coming forward, tipsters understandably want to know their rights. The lawyers at Waters & Kraus offer the skilled representation needed. Contact us or call our whistleblower attorneys at 800.226.9880 to find out more about the firm’s Medicare fraud practice and how we can help you.