Billing Fraud Case Worth $19 Million
In 2013, a New York City cardiologist with offices on Fifth Avenue and in New Jersey admitted he intentionally misdiagnosed up to 80 percent of his patients with heart problems so he could collect millions in extra Medicare money. Dr. Jose Katz, 68, pleaded guilty to falsifying charts diagnosing patients with angina and other heart ailments so he could prescribe extra tests and treatments when hundreds of patients did not need them. Prosecutors said it was the largest fraud ever executed by a single doctor in New York or New Jersey. “After years of prominence in his field, Jose Katz will now be remembered for his record-setting fraud,” said U.S. Attorney Paul Fishman.
In court, he agreed his actions could have caused “serious bodily harm” to his patients. He and his lawyer disagreed when prosecutors said some patients were at risk of death due to his actions. In all, Katz admitted his scheme took in over $19 million. Katz’s crimes went on from at least 2004 through 2012. His resume said he is affiliated with NewYork-Presbyterian Hospital, but a spokeswoman said he has not been linked there since 2003. Fishman said many patients who were exploited went to Katz’s clinics, called Cardio-Med Services in Union City, Paterson and West New York. He also ran clinics called Comprehensive Healthcare in Manhattan and Queens. Katz said he performed many so-called EECP procedures based on false diagnoses to overbill Medicare and private insurers like Blue Cross and Aetna.
In court, Katz told the judge as a doctor he had “done everything he could to help patients.” The judge told him he would have time to speak at sentencing set for July 23. After the court hearing, Katz and his attorney, Blair Zwillman, left the courthouse admitting mistakes were made but insisting Katz always cared for his patients. Katz was sentenced to 6.5 years in prison on the conspiracy to commit health care fraud charges. He also admitted creating a no-show job in his office in order to rip off more than $250,000 in Social Security benefits. Katz was born in Cuba but is a U.S. citizen. Prosecutors said he spent $6 million advertising on Spanish-language television and radio to try to lure in patients.
Medicaid Fraud Unrest
Although property crime rate is decreasing yearly in some areas, Medicaid fraud cases continue to rise. On Tuesday, December 5th, 2017, 35-year-old Kristina Mirbabayeva worked with New York doctors Dr. Hamid Alam, Dr. Kevin Custis, Dr. Jeffrey Chess, Dr. Robert Vaccarino, along with twenty people, and more than twelve corporations who were indicted and charged for Medicaid fraud. The physicians visited low-income areas, and bribed people to visit their clinic for unnecessary tests. In one case, an undercover officer was paid $30 to stay at the clinic for an hour without a doctor. The office had billed Medicaid for 18 different tests. However, it would have taken over 12 hours to complete all of these tests, in contradiction to the one hour the officer spent at the office.
The criminals laundered and transferred money to participants through over 100 bank accounts of shell companies over various nations. They also used the defrauded money to purchase expensive real estate in Brooklyn. Those who were part of the scheme could be sentenced to up to 25 years in prison.
Arkansas Doctor Guilty for Fraudulent Billing
On Monday, March 5th, 2018, Mississippi County doctor, Thomas Bailey was one of five who was arrested for health care fraud. He is accused of fraudulent billing of almost $290,000 for non-existent services and manipulating information in order to request for payment from a health plan. Bailey signed documents, falsely registering two patients as terminally ill, in order to request for services from the Medicaid program. However, Bailey’s and other health care providers’ medical records did not support Bailey’s claim that his patients were terminally ill. Bailey’s hospice billed Medicaid $289,986.46. Through 2010 to 2016, the hospice paid $141,000, while Bailey fraudulently billed Medicaid $6,280.12 for non-existing services. Bailey is charged for one count of “engaging in continuing criminal enterprise”, and his case is still being investigated by the Mississippi County Medicaid Fraud Control Unit and the U.S. Department of Health and Human Services Office.