Jun 10
28
Medicare Strike Force: More DOJ Therapy Fraud Indictments in Detroit
The US Department of Justice announced this month the indictment of yet another sham therapy operator in Detroit. According to the DOJ Press Release
Evidence at trial established that Bernice Brown was the owner and president of Wayne County Therapeutic Inc. (WCT) in Livonia, Mich. Daniel Smorynski was the vice president of WCT. WCT purported to be an outpatient clinic that specialized in physical and occupational therapy. Evidence at trial established that Brown purchased fake physical and occupational therapy files from certain third-party contractors, and she and Smorynski billed the services reflected in the files to Medicare as if WCT therapists had provided the services. Brown instructed her staff to create false documents and to add those documents to medical files to make it appear that the WCT therapists, who were licensed in the state and enrolled with Medicare, had performed the services, when she knew they had not. According to evidence presented at trial, Smorynski was in charge of billing at WCT and aided in the submission of claims for services he knew WCT did not provide. Between approximately October 2002 and September 2006, Brown and Smorynski submitted approximately $23.2 million in claims to Medicare for physical and occupational therapy services that were never provided. Medicare paid approximately $6,537,630.34 of those claims.
The ink has barely dried on the last summers round of sham therapy operator indictments as this was announced. Detroit is one of the Medicare Strike Force cities where the DOJ and other federal and state authorities have teamed to stop fraudulent Medicare billing activities. Also referenced in this indictment is the fact that the therapists were often not enrolled in the Medicare program and/or were not properly licensed to practice. As with other schemes of this type Medicare beneficiaries were “paid” a kickback fee for the use of their Medicare number, and therapy orders from physicians were fake.
Evidence at trial showed that Brown and Smorynski, in addition to submitting claims for non-existent physical and occupational therapy, caused WCT to submit fraudulent claims for psychotherapy services. In January 2006, when Congress enacted a cap on physical and occupational therapy services to control costs, Brown and Smorynski devised a scheme to avoid the cap by billing for psychotherapy services. Evidence at trial showed that Brown and Smorynski launched a lobbying effort to repeal the cap, which included WCT staff drafting letters and petitions to Congress purportedly on behalf of Medicare patients. Brown and Smorynski then instructed WCT staff to bill Medicare for their lobbying efforts as psychotherapy evaluations and visits.
It is interesting to note that in these instances were Medicare beneficiaries have been complicit in the fraud that there is no mention of future action against them. Stay tuned.
