Report on Medicare Compliance
◆ California physician Donald Woo Lee was found guilty Oct. 17 for his role in providing medically unnecessary procedures to Medicare beneficiaries, upcoding, and repackaging single-use catheters for re-use, the Department of Justice (DOJ) and the U.S. Attorney’s Office for the Central District of California said. Between 2012 and 2015, Lee recruited patients to his clinics, gave them false diagnoses of venous insufficiency, performed unnecessary vein ablation and used the wrong code to bill for them. Lee also re-used contaminated catheters. DOJ said he received $4.5 million from Medicare for the vein ablation procedures. He was convicted by a jury of seven counts of health care fraud and one count of adulteration of a medical device. Visit http://bit.ly/32tZ77M.
◆ A federal court in Cedar Rapids, Iowa, entered a $3.133 million consent judgment Oct. 16 against five home health providers in Iowa and South Dakota, the US. Attorney’s Office for the Northern District of Iowa said. DOJ had filed a false claims lawsuit against the home health providers, alleging the therapy claims they submitted to Medicare were false, because the therapy wasn’t skilled or the patients’ medical conditions didn’t justify the services. The providers are Sergeant Bluff Healthcare LLC (Iowa); Red Oak Healthcare LLC (Iowa); Logan Healthcare LLC (Iowa); Elk Point Health Care #1 LLC (South Dakota); and Flandreau Healthcare 2 LLC (South Dakota). Visit http://bit.ly/2MsFFD6.
◆ The HHS Office of Inspector General has updated its Work Plan, its road map of audits and evaluations. The Work Plan has new items on Medicare Part B payments for speech language pathology and urine drug testing services, among other things. Visit https://go.usa.gov/xVJf3.
◆ The Fraud Risk Indicator has been updated on the HHS Office of Inspector General’s website. The Fraud Risk Indicator has five categories of risk, from low to highest, that describe the degree of danger that organizations are thought to pose to federal health care programs. They mirror OIG’s 2016 risk spectrum for applying its permissive exclusion authority. Visit https://go.usa.gov/xVJfq.
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