An Englewood, New Jersey, family medicine physician is accused of billing Medicare, Medicaid and private insurance companies for office visits that never happened.
Instead of seeing the patients in person, he allegedly wrote prescriptions, authorized refills and performed other tasks without ever seeing the patients on the billed dates. He is also accused of altering and instructing his employees to alter patients’ medical charts by inserting fabricated blood pressure readings and other notations to make it appear as if patients had visited the office on dates for which he billed their insurance plans.
When one insurance plan initiated an audit after a patient reported the doctor for billing prescription refills as office visits, the physician allegedly shredded original medical records and created bogus medical records to obstruct the audit. Between 2008 and 2013, at least four individuals working at his medical offices told the doctor that his billing of prescriptions or refills as office visits was illegal.
The proceeds from suspicious billing amount to hundreds of thousands of dollars.
Albert Ades, 60, has offices in Cresskill and Little Falls, New Jersey. He was arrested and charged with fraud. If convicted he could go to prison for years and be required to pay a heavy fine.
Mental Health Scammer Gets 70-Month Sentence
An employee of Take Action Inc. and Inner Arts Inc., which claimed to provide psychotherapy services to Medicare beneficiaries residing in skilled nursing homes in the Chicago area, was sentenced to 70 months in prison for submitting false claims totaling more than $1.5 million to Medicare for psychotherapy services.
A co-defendant who was the owner and operator of Take Action and Inner Arts as well as a licensed psychologist in Illinois, was sentenced to 88 months in federal prison back in August 2014.
Bryce Woods, 37, and Keenan R. Ferrell, 55, the owner, both of Chicago, were each convicted of six counts of health care fraud at a jury trial in June 2013. They represented that Ferrell had provided 45-50 minutes of one-on-one psychotherapy to patients living in skilled nursing homes, when in fact, the sessions were conducted by Woods, psychology graduate students recruited by Ferrell, or others with limited or no supervision.
Knowing that psychotherapy services were reimbursable by Medicare only when performed by an enrolled provider or when “incident to” the services of an enrolled provider, Ferrell and Woods arranged for Ferrell, who was an enrolled Medicare provider and licensed medical doctor, to authorize Inner Arts and Take Action to accept assignment of his claims to Medicare.
Ferrell himself did not attend or otherwise participate in or supervise any therapy sessions conducted in the nursing homes.
The defendants also billed Medicare for psychotherapy sessions that Ferrell supposedly provided to patients who in fact were deceased at the time of the sessions.
In his sentencing argument Assistant U.S. Attorney Paul Tzur said, “Defendant Woods filed over 31,000 separate claims to Medicare, which was an out and out lie.”