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Stiff Penalties Continue To Be Doled Out For Medicare Fraud

You may have noticed that over the past few weeks, we have dedicated a number of our blogs to news stories covering the harsh sentences being delivered to Medicare fraudsters. Quite frankly, we couldn’t be happier to share the news that crimes involving the defrauding of our national health insurance program are met with extreme dissatisfaction by the law. And that’s putting it mildly.

It is our hope that as news of lengthy prison sentences for those who commit Medicare fraud continues to be released, incidents will become fewer. At Allegiant Experts, we take special exception to those who rob Medicare as it hurts the citizens of the United States who so greatly need insurance for their legitimate health concerns. Former Houston doctor, Warren Dailey is one such individual that we take exception to. And we’re happy to report that he will be spending the next five years of his life in jail.

As reported by Gabrielle Banks on last month, Dailey was found guilty of fraudulently squeezing nearly a million dollars out of Medicare. This past March, a federal jury in Houston convicted Dailey of one count of conspiracy to commit healthcare fraud, conspiracy to pay and receive kickbacks, payment and receipt of kickbacks and two counts of making false statements about healthcare matters.

Between August 2009 and July 2012, Dailey submitted claims to Medicare totalling $913,620 for home health care services that were neither needed nor provided to patients, Banks reports. And although the Houston court room was filled with supporters and a petition with hundreds of signatures was filed on his behalf, Dailey was found guilty of ripping Medicare off. Not surprisingly, his lawyer plans to appeal.

The pressure is on for health care professionals to be both honest and meticulous about their claims to Medicare. An abundance of false payments due to fraudulent claims is costing the program millions. And, apparently it only takes one person to rob Medicare of a fortune. Last month, on, Amy Baxter reported that an Illinois-based nursing director admitted to defrauding Medicare of a whopping $45 million!

The former director of Pathways Home Health Services, Avelina Fiel admitted to pressuring at least one of her employees to falsify medical records so that it appeared as if her patients were sicker than they really were. She also ignored doctor recommendations in order to validate her claims that many of her patients were homebound. In addition, Fiel “recycled” patients of Pathways.

“Pathways would recycle patients by billing patients for six month cycles before decertifying them for home health care,” Baxter explains, “Weeks later, the company would put that back into the home health billing cycle again. She believes 80% of the company’s patients were recycled in this way, Fiel noted, while many patients received just a check up during home health visits.” Pathways owner Josephine Tinimbang, her son Richard and daughter-in-law Maribel have all been indicted for their participation in the scheme. Their trial is set to begin in February.

As you’re aware, the Allegiant Experts team supports harsh penalties for Medicare fraudsters. And, as always, we’re willing to do our part to help the cause. If you’re an attorney, please don’t hesitate to contact us if you have any questions about how our clinical experts can help your legal battle against those who commit fraud. Give us a call at 407-217-5831.

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