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?Tweet