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.
By Sean M. Weiss, Partner, Vice President, and Chief Compliance Officer
Sean M. Weiss is a Partner and Chief Compliance Officer for DoctorsManagement, LLC. Sean provides strategic litigation defense services and a host of regulatory compliance services for clients nationally.
Learn more about Sean’s expertise at www.thecomplianceguy.com.
What to do next…
- If you need help with an audit appeal or regulatory compliance concern, contact us at (800) 635-4040 or via email at [email protected].
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