Gevork Kartashyan and Eliza Shubaralyan sentenced to Prison for Health Care Fraud – Comments by Ethics and Fraud Prevention Speaker Chuck Gallagher

The Health Care Fraud Prevention and Enforcement Action Team (HEAT) – a division of the Justice Department is at it again.  Their goal…to stop Medicare fraud…!  And, it looks like they are being effective.

Gevork Kartashyan and Eliza Shubaralyan, the owners and operators of a Los Angeles-area durable medical equipment (DME) company were sentenced to prison in connection with an approximately $1 million power wheelchair fraud scheme.  Each were sentenced to serve two years in prison and in addition, Kartashyan and Shubaralyan were ordered to serve three years of supervised release following their prison terms and to pay $400,000 in restitution, jointly and severally.

Kartashyan and Shubaralyan, who are married, were convicted at a July 2009 trial in federal court in Los Angeles. Kartashyan was found guilty of conspiracy to commit health care fraud and health care fraud, and Shubaralyan was found guilty of health care fraud. At trial, the evidence showed that Kartashyan and Shubaralyan, through their company CHH Medical Supply, billed Medicare $949,859 and were paid $597,750 as a result of the billing. According to evidence presented at trial, virtually all the billing was for medically unnecessary power wheelchairs and wheelchair accessories.

At trial, elderly Medicare beneficiaries testified about how they were recruited into the scheme. According to testimony, the beneficiaries were taken to Los Angeles-area medical clinics, where they turned over their Medicare numbers and other personal identifying information. Some beneficiaries testified that they were promised vitamins, diabetic shoes and other items that they never received, in return for providing their beneficiary numbers. According to evidence presented at trial, these clinics were in the business of generating fraudulent power wheelchair prescriptions that could be sold to DME company owners, who then billed Medicare for the wheelchairs. Many of the beneficiaries did not know they were getting a power wheelchair until it was delivered by CHH Medical Supply. All of the beneficiaries testified that they did not need or use the power wheelchairs.

Five physicians testified at trial that they never authorized or approved the power wheelchair prescriptions written under their names. Three of these physicians testified that they never worked at the clinics listed on the phony prescription pads.

According to testimony at trial, Kartashyan regularly purchased power wheelchair prescriptions. The evidence also showed that after the power wheelchairs were delivered, Kartashyan generated phony forms stating that the beneficiaries’ homes were appropriate for the use of a power wheelchair, even though no home assessment was conducted.

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.

ENOUGH SAID…any comments?

HEAT’S website can be found here.

Brooke Astor son convicted; case highlights elderly financial exploitation

At first glance it may be hard to imagine what lessons the case of late philanthropist Brooke Astor holds for everyday Americans. It’s not as if many of us have a $200 million fortune stashed under our mattresses, at risk of being stolen.

Equally improbable is the other person at the center of the case: Brooke Astor’s son, Anthony Marshall (left), a former U.S. ambassador and Broadway producer, who was accused — and just days ago, convicted — of looting his late mother’s fortune.

But if there was any doubt about the case’s relevance, the Probate Lawyer Blog dispels it. Money quote:

[The Brooke Astor case] marks an important victory in the battle against elder abuse.  The National Center on Elder Abuse reports that between one and five million elderly Americans have been the victim of financial exploitation each and every year.  Exact figures are hard to track because so many instances of abuse go unreported.

That’s why high profile cases like this one are important.  People who prey on the elderly and seek what seems like an unguarded pot of gold need to understand that they can be punished.  If Marshall had avoided jail time, then it wouldn’t have sent a strong message to the other would-be abusers out there.

QUESTION…

What can elder Americans do to protect themselves against financial exploitation?

Share your comments here.

Kansas City Internal Medicine doctors turn away Medicare enrollees, sparking ethics debate

Here’s a question for you: If you had a service to provide — and someone asked you to provide it for free, or at a radically reduced price — would you do it?

No, right?

Now try this on for size: If you were a doctor, and someone asked you to provide a service at a rate that didn’t reimburse you for the total cost of care, would you do it?

In nearly every line of business, one maxim holds true: “If you can’t pay, we don’t play.” So, why should doctors be viewed any different?

That’s the question doctors at Kansas City Internal Medicine, the largest private group practice in Kansas City, Mo., have been asking. For now, most of these doctors, who count 65 percent of their 70,000 active patients age 65 or older, have decided to stop accepting walk-in Medicare enrollees.

Dr. David Wilt, an internist at the group, tells CNN: Medicare doesn’t reimburse physicians enough to cover the cost of care. Matters will only get worse, he adds, if a 21 percent cut in Medicare payments to physicians takes place in 2010.

Should physicians be allowed to turn away patients because their funding source is being reduced? On the flip side, does the government have the right in a free-market economy to dictate payment terms to physicians for the performance of services?

Share your comments here.