Report on Medicare Compliance 29, no. 2 (January 20, 2020)
◆ The HHS Office of Inspector General has updated its Work Plan,[1] which includes an item on early discharges from inpatient rehabilitation facilities to home health.
◆ A psychiatrist from Virginia Beach, Virginia, was sentenced to 27 months in prison for cheating Medicare, Medicaid, TRICARE, and other health care benefits programs out of $450,000, the U.S. Attorney’s Office for the Eastern District of Virginia said[2] Jan. 16. Starting in 2013, Udaya Shetty billed for services that were on average 41 to 63 minutes long, but he actually only saw patients for five to 10 minutes. He overbilled at his own practice, Behavioral & Neuropsychiatric Group, and when it closed in 2017, Shetty joined another practice and engaged in a similar scheme with the help of an employee, Mary Otto, who he brought with him. The new practice was unaware of the wrongdoing. “The fraud became apparent when investigators discovered that on dozens of instances Shetty would need more than 24 hours a day of working to perform the services for which he billed,” the U.S. attorney’s office said. Shetty also settled related False Claims Act[3] allegations for more than $1 million. Otto was sentenced to 15 months in prison.
◆ San Diego-based ResMed Corp., which makes durable medical equipment (DME), has agreed to pay $37.5 million to settle False Claims Act allegations over payments to DME suppliers, sleep labs and other health care providers, the Department of Justice said[4] Jan. 15. The settlement resolves allegations brought in five different whistleblower cases. The Department of Justice said ResMed allegedly (1) gave DME companies free telephone call center services and other patient outreach services that allowed them to order resupplies for patients with sleep apnea, (2) gave free and below-cost positive airway pressure masks and diagnostic machines to sleep labs, and (3) guaranteed payments on interest-free loans that DME suppliers got from third-party financial institutions to buy equipment from ResMed. ResMed didn’t admit liability.
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