Monday, April 22, 2013

Overbilling Medicaid and Medicare by $2.5 Million: Orange Man Pleads Guilty - News - Springhill Group Florida Home Care

According to Steven M. Dettelbach, United States Attorney for the Northern District of Ohio, a man who lives in Orange, Ohio admitted to overbilling Medicaid and Medicare by more than $2.5 million.

Thirty-nine year old, Divyesh “David” C. Patel, pleaded guilty to one count of conspiracy to having been involved to health care fraud and four counts of health care fraud. Patel is anticipated to be sentenced later on this year.

Dettelbach said, “This defendant enriched himself and his company by flouting rules designed to protect the public.”

“Mr. Patel defrauded the tax payers by scamming Medicaid and Medicare,” said Stephen D. Anthony, Special Agent in Charge of the FBI’s Cleveland Field Office.

“Waste, fraud, and abuse take critical resources out of our health care system and contribute to the rising cost of health care for all Americans.”

According to court documents, Patel was the owner and president of Alpine Nursing Care Inc., located at 4753 Northfield Road, Suite 5, North Randall, Ohio, and employed Belita Mable Bush as the office manager and director of provider services from June 1, 2006 through October 18, 2009.

An additional info according to court documents is Patel and Alpine employed Bush to prepare and submit the billings to Medicaid and Medicare for reimbursement for services provided by Alpine as a home health care provider, even though Patel knew that Bush had been previously convicted of a health care-related felony that excluded Bush from being involved in any way with Alpine’s Medicaid and Medicare billings.

In addition to the fact that Bush was excluded from handling Alpine’s medical billings, Patel was aware that Bush falsified documents related to health care services allegedly provided to home health patients where the services were never provided or were provided by home health aide that had previous criminal convictions that excluded them from providing health services in people’s houses, according to court documents.

As a result of the conspiracy, Medicaid and Medicare suffered a loss of approximately $2,564,392, according to court documents.

Scheduled to be sentenced May 28, Bush was convicted on related charges.

After review of factors unique to this case, including any prior criminal record, the defendants’ role in the offense, and the characteristics of the violation then the defendants’ sentence will be determined by the court.  But in all cases, the sentence will not exceed the statutory maximum and, in most cases, it will be less than the maximum.

This case is being prosecuted by Assistant U.S. Attorney Mark S. Bennett and Special Assistant General Constance A. Nearhood, following an investigation by the Office of the Inspector General, Department of Health and Human Services, Cleveland, Ohio; Ohio Attorney General’s Office, Medicaid Fraud Control Unit; and the Federal Bureau of Investigation, Cleveland, Ohio.

A condemnation is only an accusation and is not proof of guilt.  A defendant is permitted to a just trial in which it will be the government’s responsibility to verify guilt beyond a reasonable doubt.

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