Patient recruiter handed 188 months for $20M scam in Texas

What is the penalty for fraudulently billing Medicare formore than $20 million in claims? Apparently, 188 months in federal prison. A Houston area patient recruiter for four home health care agencies and owner of one agency was sentenced this past week for money laundering and Medicare fraud. Egondu “Kate” Koko, 54, was sentenced, ordered to pay $12.9 million in restitution and to forfeit $1,378,552.00 in illegally obtained Medicare dollars. In October 2018 she pled guilty to one count of conspiracy to pay and receive health care kickbacks and one count of conspiracy to launder monetary. Koko admitted that she paid illegal kickbacks and bribes to physicians and patients to complete the necessary paperwork for the home health agencies to bill Medicare. In a money laundering scheme, she admitted she not only transferred a portion of the Medicare funds to the bank account of a Nigerian national in an attempt to hide it but also used some of the proceeds to purchase a home.

The case was a joint investigation by the U.S. Department of Health, Human Services Office of Inspector General’s (HHS-OIG) and the FBI. 

The Medicare Fraud Strike Force is part of a joint initiative between the Department of Justice, the FBI, the Office of Inspector General, the Department of HHS and local law enforcement to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 14 strike forces operating in 23 districts, has charged nearly 4,000 defendants who have collectively billed the Medicare program for more than $14 billion. In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers. 

Another recent fraud case includes a $3.3 million settlement from a group of Virginia pain management clinics, which resolved whistleblower allegations that they fraudulently billed government programs for services that were not provided. 

The former CEO of a Florida hospital chain paid $3.5 million to settle fraudulent billing allegationsin a scheme where he pressured emergency physicians to admit patients who could have been safely treated in the outpatient setting.

Most recently, a California woman was found guilty of fraud charges for her role in a $6 million Medicare fraud scheme involving billing for occupational therapy servicesthat were not medically necessary and not actually provided.

Isn’t it interesting that fraud is often overlooked in the health care debate? I think so. A massive amount of Medicare and Medicaid fraud is perpetrated by corporate executives, administrators, home health care agencies, durable medical equipment suppliers, retail pharmacies, compounding pharmacies, physicians, and patients each year. With the implementation of the Medicare Fraud Strike Force, reimbursements to a suspected perpetrator can be stopped immediately while an investigation is conducted, alleviating further loss. But, despite successful prosecution, much of the money is never recouped, leading to billions of wasted taxpayer dollars. If Medicare for All becomes a reality, I wonder how much easier it will be for predators to milk the system?

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Cynthia R Stuart DO

Dr. Stuart is Board Certified in Family Medicine. Originally from Georgia, she spent most of her youth in Miami, Florida and has been a Texas resident since the early 1990s. She attended UNTHSC-Fort Worth and completed her residency at UTSW/Methodist Hospital System where she was Chief Resident in her senior year. She is an Associate Professor at UTSW and UNTHSC, participating as a preceptor for medical students and residents. She completed a two-year course at SMU Cox School of Business in Advanced Leadership that enables her to advocate for quality health care providers and local public health programs in her community. She is the head of the Credentials Committee, sits on the Medical Executive Committee and the Ethics Committee at Baylor Scott and White Hospital of Carrollton. She has appeared on numerous news and radio programs to educate the public about various health topics. Dr. Stuart has managed her private practice in Carrollton since 2005 and is now a Direct Primary Care Physician. 

  4 comments for “Patient recruiter handed 188 months for $20M scam in Texas

  1. June 8, 2019 at 12:41 pm

    If you take their money, you too could go to prison for fraud–doctors have, for what might have been inadvertent billing error. The really big players usually get away with it. See https://www.jpands.org/vol8no3/burr.pdf and https://www.jpands.org/vol8no3/burr.pdf

  2. Leslie
    June 6, 2019 at 7:12 pm

    Having worked for a major medical insurance company, I am well aware of Medicare fraud. When I had pointed out fraud, I was told that I was spending too much time on a review and I’m not following the process flow. I had noticed similar charting on different members from DME companys and the submitted diagnosis codes had never been noted on any other physician charting.
    Claims get paid.
    Reason – the check boxes on a form are marked and physician signed.
    I could even show that the signature wasn’t authentic, comparing to other records.
    I also pointed out that there was never physician visits near on on the date of the signed order, indicating that the patient wasn’t seen.
    I was told again, I’m wasting time, I’m not following the process flow, and that I’m making assumptions, as maybe the physician office hasn’t submitted a visit claim. Wow, visit claims before and after date of service noted and still no matching diagnosis code for DME medical necessity.
    I had to quit. All the time spent allowing these payments and time spent denying “real” medical necessity issues

  3. Stevem64
    June 6, 2019 at 6:28 pm

    The system gets scammed even more on the private commercial insurance side. The insurance companies usually decide investigating the fraud and penalizing the perpetrator is too expensive. They just let it slide. It’s a business decision.
    On the other hand, when you start defrauding Tricare, Medicare or Medicaid and you have someone in the offending organization acting as an informer (which was the case in one of these examples) willing to push the issue, you’re going to eventually get caught.

  4. Pat
    June 6, 2019 at 3:50 pm

    Medicare should be phased out and abolished, but the shuffleboard set will never allow it. Medicaid should happen only at the state level, giving states the ability to scale back and adapt.

    Big bloated bureaucracies will remain an invitation to corruption, theft and waste.

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