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OIG's most wanted to alleviate concerns?

June 16, 2016
 

In every bunch there are bound to be a few bad apples. Few bunches have as bright a light shone on them as the medical community. Illumination is coming from patients, payors and the government. Even an honest doctor can have a tough time feeling immune! Which is why actually looking at the results of inquiries can sometimes make us all feel a little more secure. If you have ever wondered, "what would really get me in trouble?"  "What would I have to do to have a career ending problem?"  The answers are not that hard to find, because the Office of the Inspector General (the Medicare Police) tell you on their website!  And, they have chosen to tell you in a way by creating an exact replica to the "would have been" website to the TV show "America's Most Wanted".  

Here is the OIG Site - http://oig.hhs.gov/fraud/fugitives/.  

What's most notable to me is when looking at Medicare's most offensive offenders, the ratio of healthcare practitioner to lay person is pretty low.  Of the examples of healthcare practitioners we see charges of blatant falsification of services being rendered - 
  • OIG Fugitive: Uche Chukwudi

  • On December 19, 2013, Dr. Uche Chukwudi was indicted on charges of health care fraud and conspiracy to commit health care fraud. Investigators believe that Dr. Chukwudi was involved in a scheme to fraudulently bill Medicare approximately $7.3 million for durable medical equipment (DME) that was never provided and was medically unnecessary.
  • Co-conspirator Adeline Ekwebelem owned Adelco Medical Distributors, a DME supplier in Gardena, California. According to the indictment, Ekwebelem paid marketers to solicit Medicare beneficiaries and offer them free DME, such as power wheelchairs, hospital beds, and orthotics, that they did not need. In return for the free products, the beneficiaries agreed to visit certain physicians, including Dr. Chukwudi, who would then use their beneficiary information to create false patient files and false statements in "face-to-face examination" forms. Dr. Chukwudi and other physicians then wrote prescriptions for the DME to be filled at Adelco.
  • Dr. Chukwudi referred more than 200 Medicare beneficiaries to Adelco for expensive, medically unnecessary DME, which enabled Ekwebelem to falsely bill Medicare for approximately $1.18 million. Dr. Chukwudi allegedly received cash kickbacks in return for writing the fraudulent prescriptions.
  • Ekwebelem was convicted on charges of conspiracy to commit health care fraud, health care fraud, and paying kickbacks for the recruitment of Medicare beneficiaries. Dr. Charles Okoye, a physician who referred more than 200 beneficiaries to Adelco, pleaded guilty to conspiracy to commit health care fraud. Both are awaiting sentencing. Patient recruiters Cindy Santana, Maritza Hernandez, and Romie Tucker, Jr., each pleaded guilty to illegal remunerations for health care referrals. Hernandez received 9 months in jail, while Santana and Tucker are awaiting sentencing.
  • Dr. Chukwudi fled the United States prior to his trial in September 2014. His whereabouts are currently unknown, and he remains a fugitive at-large.
  • OIG Fugitive: Gautam Gupta

  • On June 13, 2011, an arrest warrant was issued against Gautam Gupta, charging him with health care fraud, mail fraud, and conspiracy to commit fraud. Dr. Gupta and his associates allegedly received approximately $25 million in reimbursements from Medicaid and private health insurers for medical services that were either unnecessary or not performed.
  • Dr. Gupta owned and operated the Nutrition Clinic, a weight loss clinic with several locations in Northern Illinois and the Chicago metropolitan area. According to the arrest warrant, the clinic required new patients to undergo medical tests, such as thyroid ultrasounds and echocardiograms, without regard to medical necessity for the tests. The Nutrition Clinic would then submit claims to Medicaid and private insurance companies, indicating that these tests were related to a specific medical diagnosis.
  • The clinic also allegedly submitted claims for "evaluation and management" services performed by Dr. Gupta, when in actuality neither Dr. Gupta nor any other medical doctor saw these patients. In addition, investigators found that Dr. Gupta directed office staff to enlist insured patients for additional procedures, such as "nuclear stress tests" that were not medically necessary. The clinic would then bill the patients, Medicaid, and private insurers for those services.
  • Authorities believe that Gupta is currently residing in India.
  • On July 14, 2011, the U.S. Attorney for the Central District of Illinois issued another news release related to Dr. Gupta: Indictment Charges Two Doctors with Defrauding Medicaid, Insurance Companies of $24 Million in Operation of Weight-Loss Clinics
Another reason this website does not have MDs DOs and other practitioners littering the pages is also because there is most likely a higher rate of settlement between OIG and healthcare practitioners.  

To check out the full site - click here. 
 




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