Thread: Physical Therapist Pleads Guilty to Medicare Fraud

Department of Justice
Office of Public Affairs
FOR IMMEDIATE RELEASE
January 25, 2010

Physical Therapist Pleads Guilty in Connection with Detroit Home Health Care Fraud Scheme

Detroit-area resident Jessica Vigil pleaded guilty today for her role in a Detroit-area home health care fraud scheme, announced Assistant Attorney General Lanny Breuer of the Criminal Division; U.S. Attorney for the Eastern District of Michigan Barbara L. McQuade; Special Agent in Charge Andrew G. Arena of the FBI’s Detroit Field Office; and Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services, Office of the Inspector General’s (HHS-OIG) Chicago Region.

Vigil, 34, pleaded guilty today to one count of conspiracy to commit health care fraud before U.S. District Court Judge Denise Page Hood of the Eastern District of Michigan. At sentencing, scheduled for May 27, 2010, Vigil faces a maximum sentence of 10 years in prison and a $250,000 fine.

According to plea documents, Vigil, a licensed physical therapist, admitted that she began working in approximately September 2008 as a therapist at All American Home Care Inc., and associated entities (All American). All American purported to provide home health services to Medicare beneficiaries in the Detroit area, including physical and occupational therapy services. Vigil admitted that she and other co-conspirators created fictitious therapy files, appearing to document physical and occupational therapy services provided to Medicare beneficiaries, when in fact no such services had taken place.

Vigil admitted that her role in the conspiracy was to sign documents, including start of care packages, recertification forms and discharge papers that facilitated All American’s ability to bill Medicare for home health visits. These documents allowed All American to commence, continue or conclude the purported treatment of patients and the Medicare billing cycle. Vigil admitted that she was paid between $80 and $100 by the owners of All American for each form she signed. In total, Vigil was paid more than $127,000 for signing the forms. In the course of the scheme charged in the indictment, Vigil signed documents used to justify approximately $2.375 million in home health claims paid by Medicare to All American for patients Vigil either never saw or for whom home health services were medically unnecessary. Vigil admitted that she knew the files she helped falsify were used to justify fraudulent billings to Medicare.

This case is being prosecuted by Senior Trial Attorney John K. Neal and Trial Attorney Gejaa T. Gobena of the Criminal Division’s Fraud Section. The case is being investigated by the FBI and the HHS Office of the Inspector General (HHS-OIG). The case was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of Michigan.

Since their inception in March 2007, Strike Force operations in seven districts have obtained indictments of more than 500 individuals who collectively have falsely billed the Medicare program for more than $1 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov

http://www.justice.gov/opa/pr/2010/Janu ... m-083.html

Wow. I knew there was some fraud going on...but I had no idea that there was so much fraud and so many fraud cases. Amazing. People getting care they dont need, the government paying for care that neve took place. Meantime, tons of people who DO NEED CARE are going without care.

I remember getting my mother's medical bills, which showed she was receiving "services" that I knew she never got. I called Medicare and reported it. They investigated and prosecuted the vendors. I did this every time I saw something suspicious. WE need to be doing this, to catch these criminals.

Contrary to what people believe, Medicare is NOT free to senior citizens. They deduct at least $100 per month from your social security. In addition, you have to pay for individual health insurance since Medicare is SUPPLEMENTARY.

My mother was paying $600 every 3 months for BC/BS in addition to the $100 per month in Medicare premiums..$900 per quarter = $3600/year for ONE old lady ON Medicare. So tell me again, how "free" Medicare is for seniors???

MediCAID, on the other hand, is FREE to people who have never paid a dime into it, who's going after that???

Miguelina I did the same thing with my Dad's bills. He went in for open heart surgery and after the fact I saw more doctors than you could shake a stick at. yes, they were his "Doctor" in one way or another but they had nothing to do with the surgery. At first I thought they were being nice just dropping in to say hello... WRONG! They were sticking their head in the door so they could add a Medicare charge!

When my Mom and I were going over the bills I blew a gasket! I called Medicare and turned each and everyone of those bloodsuckers in. I wish I could say I know what happened, but I can say I felt better for having done it! The woman I talked to at Medicare was polite and I took the time to point every detail I wanted to dispute.

Originally Posted by miguelina

MediCAID, on the other hand, is FREE to people who have never paid a dime into it, who's going after that???

I see as many articles and press release about Medicaid fraud being convicted as I do Medicare fraud. I don't post each and everyone of them here, but they are out there and being investigated.

GOOGLE ( Medicaid fraud ) and/or ( Medicare fraud ) for more articles and info.

Lawmakers Target Medicare and Medicaid Fraud - WSJ.comOct 28, 2009 ... Lawmakers said the government needs to step up efforts to fight Medicare and Medicaid fraud to generate more savings to help pay for a ...
online.wsj.com/article/SB125676965747314335.html - Cached

South Carolina Attorney General Henry McMaster -
Crime and Fraud ...Medicaid is uniquely vulnerable to fraud because of the huge sums of money and ... And Medicaid fraud cases have rarely been prosecuted by state or federal ...
www.scattorneygeneral.org › Crime and Fraud - Cached - Similar

National Association of Medicaid Fraud Control Units (NAMFCU ...Founded in 1978, the National Association of Medicaid Fraud Control Units (NAMFCU) has played a pivotal role in providing the Medicaid Fraud Control Units ...
www.namfcu.net/ - Cached - Similar

Florida Attorney General - Medicaid Fraud Control Unit
The Medicaid Fraud Control Unit became part of the Attorney General's Office in July, 1994, and brought with it responsibility for policing what has become ...
myfloridalegal.com/.../ebc480598bbf32d885256cc6005b54d1!OpenDocument - Cached - Similar

Unlikely Suspects in Medicaid Fraud Cases in New York -
NYTimes.comOct 30, 2009 ... A painter with properties in the Hamptons, a dentist and a freelance artist who owns apartments in Manhattan were indicted on charges that ...
www.nytimes.com/2009/10/30/nyregion/30scam.html

Medicaid Fraud The Virginia Medicaid Fraud Control Unit (MFCU) was established in 1982 to investigate and prosecute insurance fraud against the federally funded Medicaid ...
www.oag.state.va.us/CONSUMER/MEDICAID_FRAUD/ - Cached - Similar

News results for Medicaid fraud
TopNews United States Dental clinic settles Medicaid fraud case with Kansas ties‎ - 5 days ago

Forba Holdings LLC, a manager of dental clinics, agreed to pay $24 million to settle lawsuit claims it caused bills to be submitted to Medicaid for unneeded ...
Kansas City Star - 170 related articles »