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Articles Tagged with healthcare fraud

Two Chicago physicians are charged with prescribing opioids to patients who had no legitimate need of them, according to a federal indictment announced on the Department of Justice’s website. According to the charges, the two prescribed high-dose narcotics such as fentanyl and oxycodone to patients without conducting a meaningful examination or medical tests. The doctors are accused of knowingly dispensing the drugs to patients whom they knew for a fact had no legitimate medical need for high-powered opioids.

Further, the two physicians are accused of colluding after one of the two named in the indictment lost his license to prescribe medicine. That physician used another physician to fill prescriptions, and now they are both going to be charged with fraud, trafficking controlled substances, and more. Another element of the crime is the fact that the physicians sought Medicaid and Medicare reimbursement for the improper prescriptions. 

The Opioid Crisis

hush-naidoo-382152-copy-300x200The government is trying to review and reform the healthcare system, but there are still some people in Chicago who are committing Medicaid fraud. There are many fraud prevention measures that have been put in place. Yet, there are people who work to see how they can deceive the government.

This is a serious offense that can lead to serious jail time. Recently, Santila Terry, a 45-year-old woman who lives in Chicago, was facing charges for committing both identity and Medicaid fraud. The total estimated loss in the case was almost $1 million. This case is typical in terms of how frauds of that nature are committed.

A service provider bills the government for services that were never delivered right up until they are discovered. According to reports from the Attorney General, Santila was claiming to provide speech therapy to people who did not exist. Another part of the case was identity fraud. Special Therapy Care Chartered used the personal information and Medicaid service provider ID of a previous employee to falsely bill the government.

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Healthcare fraud has been raised as a matter of concern not only in Chicago but in the country as a whole. It raises the costs of providing healthcare and also means that vulnerable people who need support are left behind. The cases in this category are unique because they often provide a corporate entity that is tasked with the role of distributing healthcare services. The large scale Medicare fraud occurs within the modalities of overcharging the state or alternatively charging it for services that were never delivered. In either case, the consequences for those involved can be dire. They could lose the license to practice and may be banned from government contracts for a considerable period of time.

Over time, a number of fairly consistent patterns of offending have emerged. First of all, there are three main modalities including Medicare Fraud, Medicaid Fraud, and Kickbacks. Each of these modalities are united by deceit and illegal benefits. For example, overbilling has been a persistent problem in Medicaid and Medicare programs, despite the stringent protective measures that were adopted by Congress and local legislatures. In some cases, the service provider is so overwhelmed by paperwork and bureaucracy that they end up making inadvertent mistakes. Obviously the courts will take into consideration both the act and the intention behind it before passing judgement.

Damaging the Integrity of the System

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