Medicare Fraud - Telemarketing - DoctorsManagement Medicare Fraud - Telemarketing - DoctorsManagement

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THE COMPLIANCE GUY BLOG

Medicare Fraud – Telemarketing

August 12, 2021

by Sean Weiss, Partner & VP of Compliance

Here we go again! 2 Nurse Practitioners (1 male and 1 female) in Montana were sentenced for conspiring to defraud Medicare. How is it that folks think they can do these kinds of things and actually get away with it? You may pull it off for a period of time but the investigatory agencies will always catch you!

Both of these Nurse Practitioners pled guilty to conspiracy to commit health care fraud by engaging with telefraud (telemarketing) companies to sign brace orders that were prepared by telemarketers who had no medical training or certification.

One NP routinely signed orders for Medicare beneficiaries regardless of medical necessity. This NP signed approximately 7,673 brace orders, which resulted in $8,259,849 billed to Medicare, of which Medicare paid approximately $4,307,934. The NP was paid at least $94,395 for the orders she signed.

The second NP received money to sign unnecessary brace orders for Medicare beneficiaries regardless of medical necessity, often without ever talking to the Medicare beneficiary to determine whether the braces were medically necessary. This NP signed approximately 7,097 brace orders, which resulted in $10,055,436 billed to Medicare, of which Medicare paid approximately $5,054,866. The NP was paid at least $124,900 for the orders he signed.

What to do next…

  1. If you need help with an audit appeal or regulatory compliance concern, contact us at (800) 635-4040 or via email at info@drsmgmt.com.
  2. Read more about our: Total Compliance Solution

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Experienced compliance professionals. Our compliance services are structured by a chief compliance officer and supported by a team that includes physicians, attorneys and a team of experienced auditors. The team has many decades of combined experience helping protect the interests of physicians and the organizations they serve.

Quality of coders and auditors. Our US-based auditors receive ongoing training and support from our education division, NAMAS (National Alliance of Medical Auditing Specialists). All team members possess over 15 years of experience and hold both the Certified Professional Coder (CPC®) as well as the Certified Professional Medical Auditor (CPMA®) credentials.

Proprietary risk-assessment technology – our auditing team uses ComplianceRiskAnalyzer(CRA)®, a sophisticated analytics solution that assesses critical risk areas. It enables our auditors to precisely select encounters that pose the greatest risk of triggering an audit so that they can be reviewed and the risk can be mitigated.

Synergy – DoctorsManagement is a full-service healthcare consultancy firm. The many departments within our firm work together to help clients rise above the complexities faced by today’s healthcare professionals. As a result, you receive quality solutions from a team of individuals who are current on every aspect of the business of medicine.