Wednesday, April 3, 2013

South Jersey Doctor Admits Making Half-a-Million Dollars in Fraud Scheme Involving Home Health Care for Elderly Patients

The owner, founder and physician of Visiting Physicians of South Jersey—a Hammonton, New Jersey provider of home-based physician services for seniors—pleaded guilty today for charging lengthy visits to elderly patients that they did not receive, U.S. Attorney Paul J. Fishman announced.
52 year-old Lori Reaves of Waterford Works, New Jersey, entered her guilty plea to information charging her with one count of health care fraud before U.S. District Judge Freda L. Wolfson in Trenton federal court.  Reaves was led to her receiving at least $511,068 in criminal profits because at some stage in her guilty plea she confessed about lying in Medicare billings about the amount of face-to-face time she spent with patients.  According to court documents, the physician was the highest-billing home care provider among the more than 24,000 doctors in New Jersey from January 1, 2008 through October 14, 2011.
“Today, Lori Reaves, a South Jersey physician, admitted intentionally overbilling Medicare and pocketing more than half a million dollars she didn’t earn,” U.S. Attorney Fishman said. “The Medicare system depends on doctors and other medical professionals truthfully billing for services they actually provide. Here, Dr. Reaves chose to lie about the major service she was providing to her homebound, elderly patients: her time.”
According to documents filed in this case and statements made in court:
Visiting Physicians of South Jersey (VPA) made home-based physician health care for elderly and homebound patients in New Jersey available, tendering services throughout South Jersey.  Reaves was accountable for VPA’s Medicare billings as a Medicare-approved provider as part of her responsibilities at VPA.
A procedure code called a Current Procedural Technology (CPT) code is required together with a physician to state a diagnosis to be submitted by the health care provider to identify services rendered.  Medicare regulations necessitate that each provider attest that the services rendered were medically essential and were supplied by that provider.  A word of warning at the base of the form particularly says that any fake claims or declarations in accordance to the compliance of a claim for reimbursement are prosecutable under federal or state law.
Reaves presented forms that fallaciously claimed she had endowed with extended service visit to her patients just so she can to persuade Medicare to make payments to her that were extensively higher than the payments she only deserves in many occasions at some stage in the pertinent time phase.
Reaves habitually billed Medicare by means of codes that would have mandate her to spend between 60 and 150 minutes with a patient.  This practice is under Medicare regulations and depending on the corresponding service but many of the claims Reaves submitted would have required her to spend a minimum of two-and-a-half hours of face-to-face time with her elderly clients, when she actually spent far less.
Therefore, Medicare reimbursed Reaves more than $511,068 for the fraudulent prolonged service visits Reaves claimed to have made.  This is exactly why we cannot really trust anyone, watch out for scams and read and know fraud prevention tips.
Reaves is now facing  a maximum possible penalty of 10 years in prison and a fine of the greatest amount of $250,000 or twofold the gross gain or loss caused by her offense.  It will also be a compulsory to forfeit the proceeds of her crime. Sentencing is at this time scheduled for July 13, 2013.
The government is represented by Assistant U.S. Attorneys Deborah J. Gannett and R. David Walk Jr. of the U.S. Attorney’s Office Health Care and Government Fraud Unit in Newark while U.S. Attorney Fishman credited special agents of the FBI in Newark, under the direction of Acting Special Agent in Charge David Velazquez, and special agents of the Department of Health and Human Services, Office of Inspector General, under the direction of Special Agent in Charge Tom F. O’Donnell of the New York Regional Office, with the investigation leading to the guilty plea.

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