A medical license is a highly prestigious credential signaling that the holder has completed rigorous training and has been approved by his or her peers as having the skills, knowledge, and experience to provide medical care. Physicians as a group are among the highest income earners in the United States, a fact with which hardly anyone would take issue. Doctors make a lot of money because they sacrificed years of their lives to attain a body of knowledge that makes them highly valued in society. It should be evident that a license to practice medicine is not a license to game the Medicare system, but not everyone gets that message.
Last Thursday, a 58-year-old physician in Porter Ranch, CA, was arrested by Federal authorities and charged with $6 million in fraudulent billings to Medicare. According to the complaint, the doctor, who operated two home health clinics in Tujunga and Reseda, falsely certified patients to receive care and submitted reimbursement claims for services that were either not provided or were medically unnecessary. If this physician is convicted on all counts, she faces up to 40 years in prison.
The doctor allegedly ran a scheme between 2012 and 2018 in which doctors, nurses, and therapists certified patients for home care instead of sending them to a hospital or skilled nursing facility. Once the patients were at home, the doctor’s clinic filed claims with Medicare to be reimbursed for such services as injections or teaching a patient’s family how to administer care. Apparently, the doctor did not believe anyone would either notice or care that the clinics’ home health care certifications were fraudulent if the charges are proven correct.
Why are doctors performing Medicare Fraud?
Medicare dollars are intended to care for our elderly population, not to line the pockets of a health care providers through fraudulent business schemes that exploit our seniors.
At York Law Firm, we have seen countless examples of greed and instances of corporate health care providers exploiting senior care for their personal financial gain. The only way to prevent fraudulent Medicare claims is to remain eternally vigilant. Hoping that all doctors and other highly trained professionals will do the right thing is not a workable or winning strategy.
Attorney Wendy York of York Law Firm specializes in prosecuting elder abuse and wrongful death cases. If you are in need of legal assistance please contact Wendy York today!