If we’ve learned anything in our line of work, it’s that there’s no shortage of health care fraud incidents to discuss. Each and every day, it seems as if a new story from a different part of the country pops up about someone taking advantage of Medicare and other health insurance programs. This week, of course, is no different.
Earlier today, Ryan Smith of Insurance Business America revealed that a Virginia woman has been convicted of scamming no less than $83 million from Medicare and private insurers. According to his report, 44 year-old Yung Yi was convicted this past Monday of seven counts of health care fraud, one count of conspiracy to commit health care fraud and wire fraud, one count of conspiracy to defraud the United States and one count of filing a false tax return.
Yi ran unnecessary sleep studies.
Citing local news affiliate WTOP as his source, Smith reports that Yi ran the 1st Class Sleep Diagnostic Center and 1st Class Medical. Prosecutors claim that patients who were referred by their doctors to visit 1st Class for sleep studies were asked to participate in medically unnecessary studies. Yi kept the scam under wraps by instructing her employees to keep the results away from the referring doctors.
In addition, she informed her patients that no co-payments or co-insurance for the supplemental studies were available, but cross-billed patients from each of the 1st Class entities. A report about the case from the Loudon Times-Mirror provides further clarification about Yi’s actions. “The cross-billing between the two lead entities alone was approximately $4 million,” the report details, “Yi also used the original referring doctors’ names and identifying information on health insurance claims without their permission, evidence showed.”
Yi didn’t stop there.
She even went so far as encouraging her own employees to get unnecessary sleep studies. “For example, three 1st Class employees had 27 sleep studies done among them in less than three years – even though none of them had sleep apnea,” writes Smith, “Teams of workers also held competitions to see who could refer the most friends and relatives for unnecessary studies.”
Yi made sure to enjoy the money she was fraudulently making from her Medicare claims for these studies. Among her lavish purchases were fur coats, luxury vehicles, a Rolex watch, a $1.1 million house, several condos and other properties in Chicago and Honolulu. “All the properties were booked as business expenses,” informs Smith, “She also created a fraudulent charity to hide the money from law enforcement.”
U.S. attorney for the Eastern District of Virginia, G. Zachary Terwilliger had this to say: “Yi lied to, cheated, and stole from taxpayers and insurance companies. When someone commits health care and tax fraud it drives up the cost of care for everyone and creates an un-level playing field. Yi misled patients and their doctors, falsified records to cover it up, and deducted millions in taxes she used to buy expensive properties and luxury goods.”
Yi’s sentencing is scheduled for November 2nd.
If you’re an attorney working a health care fraud case, please don’t hesitate to reach out to Allegiant Experts to find out how we can help you. Our experts have been providing expert clinical services for over 15 years and can help your team by bridging the disciples of medicine, coding and billing to ensure accurate payment and data is achieved. Call us at 407-217-5831 or email us at firstname.lastname@example.org.