KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Medicare Fraud Round-Up: N.D. Beneficiaries Getting Illegal Phone Calls, Doctor Indicted In Ohio

The Bismarck Tribune reports on a new scheme "asking seniors to pay up for not having Part D coverage. The scammers have been calling beneficiaries saying they owe a penalty for not having the Part D prescription drug coverage and that they need to pay the fine right away, said a release from the office of the Insurance Commissioner" (1/20). 

The Fargo, N.D., Inforum also reports that state insurance officials were warning beneficiaries that "Medicare cannot call and ask for your financial or personal information over the phone. Always keep your personal information - including your Medicare number safe, just as you would a credit card or a bank account number. A Medicare drug plan may accept payments by phone, but they cannot call beneficiaries to request a payment be made. The beneficiary must be notified of the past due premiums via mail" (1/20).

Columbus Business First reports on the arrest Wednesday of a Columbus doctor, Dr. Charles C. Njoku, and his office manager, Veronica Scott-Guiler, in a Medicaid and Medicare fraud case. The two were "brought up on more than a dozen federal charges each tied to an alleged health-care fraud scheme to the tune of more than $100,000. ... The alleged fraud scheme took place from early 2005 through 2009 and involved billing the government programs for visits and tests that weren't provided as billed" (1/20).

The Columbus Dispatch reports that the charges in that on the same case include: "14 counts of making false statements in connection with the payments, with a possible maximum sentence of five years in prison; one count of health-care fraud, with a maximum of 10 years; and four counts of illegal distribution of controlled substances, with a maximum of 20 years. Njoku also is charged with one count of distributing a controlled substance without the required form, punishable by a maximum of four years" (Futty, 1/21). 

Florida Today reports that criminal charges are unlikely in a Medicare fraud case there: "Cancer doctors from Brevard County's largest physician group probably will not face criminal charges even as their company negotiates hefty civil fines and penalties in a Medicare fraud case, says a former federal prosecutor who handled similar cases. The U.S. Justice Department seeks millions of dollars it says Melbourne Internal Medicine Associates obtained through fraudulent claims for expensive radiation cancer treatments that were either unnecessary, duplicative or never performed. Federal agents launched an investigation in October after a whistleblower stepped forward" (Schweers, 1/20).

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