No sector of the health care industry is free from the stain of Medicare fraud. Even hospice operators, who are duty bound to make the final days of their patients as comfortable as possible, are involved.
Take a recent case involving the chief operations officer of Horizons Hospice LLC. She was indicted by a grand jury in Pittsburgh on charges of health care fraud and making false declarations before a grand jury.
The indictment named Mary Ann Stewart, 47, of Bossier City, Louisiana, as the sole defendant.
Horizons Hospice provided end-of-life care to eligible patients. A significant number of patients were eligible for Medicare and Medicaid. The indictment alleges Stewart orchestrated a scheme whereby she caused her staff to place non-qualifying patients into hospice care that were not appropriate, and then recertified the patients for continued hospice care.
The indictment also alleges that Stewart testified untruthfully to questions before a federal grand jury.
The law provides for a maximum total sentence of 10 years in prison on the health care fraud count and five years in prison on the making false declarations before a grand jury counts, a fine of $250,000 on each count, or both.
In other recent health fraud cases:
- The owner of a home nursing agency has been sentenced to 92 months in prison for fraudulently billing millions of dollars of services to Medicare and then laundering the proceeds. Michael Galatis, 63, of Natick, Massachusetts, must also pay a $50,000 fine, $7 million in restitution to Medicare, and will forfeit proceeds of the fraud scheme, including his house, valued at $850,000. Galatis, who is also a registered nurse, owned and operated At Home VNA, a home health agency located in Waltham, Massachusetts. From 2006 to 2012, he submitted more than $27 million in false and fraudulent home health care claims to Medicare. Medicare paid more than $20 million of those fraudulent claims.
- A former Michigan resident who directed a $3.3 million psychotherapy fraud scheme was given 87 months in prison. Gerald R. Funderburg Jr., 35, of Syracuse, New York, was also ordered to pay $1,453,064.59 in restitution. According to his guilty plea, from November 2006 through April 2011, Funderburg owned and controlled Funderburg Clinical & Community Services, which he used to submit false claims to Medicare for purported psychotherapy services. Funderburg admitted that he used the Medicare information and identities of hundreds of Medicare beneficiaries without their consent to submit claims for psychotherapy services that were not actually provided.