October 29, 2013 — Every year, the U.S. Department of Justice counts on information from whistleblowers to recoup millions of dollars that might otherwise be lost to Medicare fraud schemes. The qui tam provisions incorporated in the federal False Claims Act arm inside employees with the tools necessary to help combat fraud in the health care industry. In return for filing suit on the government’s behalf, tipsters retain a portion of any recovery from the suit.
Adult Day Care Centers Billed Medicare for Psychotherapy Services Never Provided
The owner and the program coordinator of two adult day care centers in Flint, Michigan have been convicted for their roles in a $3.2 million Medicare fraud scheme. The federal jury in Michigan found Glenn English guilty of health care fraud and conspiracy to commit health care fraud. Richard Hogan was convicted on one count of conspiracy to commit health care fraud.
English owned and operated New Century Adult Day Treatment Inc. and New Century Adult Day Program Services LLC (collectively, New Century). English and Hogan concocted a scam to lure in patients to New Century by recruiting mentally disabled residents of adult foster care homes and people looking for narcotic drugs. English and Hogan told those looking for drugs that if they agreed to participate in the operation, a New Century doctor would prescribe narcotics for them. The men would use the recruits’ names and Medicare billing information to submit false claims to Medicare for psychotherapy that the recruits never received.
English instructed that New Century employees should create phony patient records, such as fabricated progress notes, to make it appear that psychotherapy was being provided. The New Century recruits were directed to sign months of sign-in sheets in one sitting. English and Hogan would then use the sheets to support their phony claims to Medicare. Several times, New Century submitted claims to Medicare for a social worker’s administration of more than 24 hours of psychotherapy in a single day.
According to the Justice Department, between March 2010 and April 2012, New Century billed Medicare for around $3.2 million and received over $988,000 in reimbursements.
Conscientious Health Care Workers Key to Fighting Medicare Fraud
False Claims Act violations involving phony Medicare claims like those in this case frequently involve the forced participation of health care employees. Rather than participate in a fraud, many health care workers would rather collaborate with the Justice Department. The qui tam attorneys with Waters & Kraus provide brave and conscientious informants with the legal representation they deserve. Send us an email or contact our False Claims Act attorneys by phone at 855.784.0268 to learn more about filing a whistleblower lawsuit.