Recent federal anti-fraud efforts productive

One of the schemes touted by the Obama administration as a means to help pay for healthcare reform appears to be having some effect. Added resources provided to law enforcement and regulatory agencies have produced some impressive results in a remarkably short period of time.

Last year a Houston Podiatrist and a co-defendant were arrested on federal charges of submitting false and fraudulent claims to both the Medicare and Medicaid health care programs. Franklin Beltre, DPM, was actually out of the state for much of the time, while the services were performed instead by co-defendant Manuela Alana, an unlicensed, unsupervised podiatrist. Both defendants accepted a plea bargain with Beltre this month receiving a 36-month sentence and Alana sentenced to 24 months.

On June 17th, Dr. John Edward Perry III, MD, age 47, of The Woodlands, Texas, and Kate Ose Olear, age 43, a Nigerian national residing in Houston, have been convicted of conspiracy to commit healthcare fraud. Durable medical equipment company (DME) owner Olear billed Medicare $2.8 million for unnecessary arthritis kits, with authorization from Perry, for more than 683 beneficiaries – some of whom were deceased.

Also on June 17th, 50-year-old Nicodemus Udofia of Tyler, Texas, was arrested by a joint team of state and federal investigators. Udofia, the owner of a Tyler DME, is charged with multiple counts of health care fraud, wire fraud, illegal remunerations, and aggravated identity theft.

Then on June 21^st, four Houston-area home health agency owners and three of their employees were charged for alleged participation in a $5 million Medicare fraud scheme. Clifford Ubani, 52; Ezinne Ubani, 45; Princewill Njoku, 51; Caroline Njoku, 45; Mary Ellis, 54; Michelle Turner, 42; and Cynthia Garza-Williams, 49, are charged with a variety of counts, including conspiracy to commit health care fraud, paying and/or receiving kickbacks, and making false statements in the submission of claims to the Medicare program.

The investigations all are part of the Medicare Fraud Strike Force; a joint effort by agents of the U.S. Department of Health and Human Services, the Office of Personnel Management, Drug Enforcement Administration Diversion Division, Texas Attorney General Medicaid Fraud Control Unit, United States Railroad Retirement Board and the FBI.

These are just a few cases from my home state of Texas that have been in the news over the past couple of weeks. The year-old strikeforce teams (dubbed HEAT) deployed across the country are being very effective. Nationwide, in just the first half of 2010, their efforts are being credited with the recovery of more than $3 billion, including $670 million in audit receivables and $2.5 billion in investigative receivables. For every dollar invested in the program, four dollars are being recovered and returned to the trust fund.

1,935 individuals and entities have been excluded from participating in federal health care programs. Additionally, 293 criminal actions and 164 civil actions have been initiated. Several criminals are already serving time.

The HEAT teams are weeding the patch, reducing false claims recovering ill-gotten monies and jailing the bottom feeders. Far more importantly, the honey pot has been salted. The formerly low-hanging fruit of federal money has become become incredibly difficult and more risky, resulting in fraudsters not quite so as anxious to apply for a provider number.

The Obama administration’s healthcare cost containment efforts are effective but largely unnoticed by the mainstream press. However, he wins a gold star from this blogger.

Additional resources and news HERE, HERE and HERE.

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