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NJ Doctor Pleads Guilty to Medicare Fraud

Doctor Admits She Committed Medicare Fraud Through Overbilling

A doctor based in Hammonton, New Jersey pled guilty to one count of Medicare fraud.

Dr. Lori Reaves, who owns and runs Visiting Physicians in New Jersey, pled guilty on March 28th to fraudulently charging Medicare for lengthy visits that her elderly clients did not actually receive.

Visiting Physicians provides in-home physician services for seniors.

Reaves admitted that she lied to the federal health agency about the amount of face-time she spent with her patients, so she overbilled Medicare by at least $511,000.

Court documents show that Reaves was the highest-billed home health care provider in New Jersey between Jan. 1, 2008 and Oct. 14, 2011.

“The Medicare system depends on doctors and other medical professionals truthfully billing for services they actually provide,” U.S. Attorney Paul J. Fishman said. “Dr. Reaves chose to lie about the major service she was providing to her homebound, elderly patients: her time.”

According to court documents, Reaves billed Medicare using codes that required her, under federal regulations, to spend between 60 and 150 minutes with her patients. Many of her claims specified that she spent at least 2.5 hours with patients, when in fact she only spent 30 to 45 minutes with each patient.

Reaves faces up to 10 years in prison and must forfeit the proceeds of her crime. She will most likely have to repay the $500,000 she fraudulently received from Medicare, as well. Sentencing is scheduled for July 13th.

Medicare Fraud is a Federal Offense

Medicare Fraud in the United States refers to a federal crime in which an individual or corporation seeks to fraudulently collect Medicare health reimbursement under false pretenses.

The amount of money lost to Medicare fraud is difficult to track, because so many seniors use Medicare to cover their extensive medical expenses. According to the Office of Management and Budget, “improper payments” from Medicare went up to $47.9 billion in 2010, with total Medicare spending at $528 billion. However, after investigation, many of the assumed fraudulent claims turned out to be valid.

Medicare fraud is typically seen in the following ways:

1.    Phantom Billing: The medical provider bills Medicare for unnecessary procedures, or procedures that are never performed; for unnecessary medical tests or tests never performed; for unnecessary equipment; or equipment that is billed as new but is, in fact, used.

2.    Patient Billing: A patient who is in on the scam provides his or her Medicare number in exchange for kickbacks. The provider bills Medicare for any reason and the patient is told to admit that he or she indeed received the medical treatment.

3.    Upcoding scheme and unbundling: Inflating bills by using a billing code that indicates the patient needs expensive procedures.

The Department of Justice Medicare Fraud enforcement efforts rely heavily on medical professionals to report any information they have about Medicare fraud. These reports fall under False Claims Act violations, and are prosecuted by the federal government. Changes to whistleblower or qui tam claims make it easier for employees to safely report any Medicare fraud they see. However, whistleblower rules do stipulate that accusers must have first-hand knowledge of fraud.

The Strom Law Firm Protects Medicare Fraud Whistleblowers in South Carolina

If you have first-hand knowledge of government fraud occurring at your place of employment or your doctor’s office, including Medicare fraud, the attorneys at the Strom Law Firm can help protect your rights. In order to help the government provide the best possible services, Medicaid and Medicare fraud must be reported as soon as possible. The attorneys at the Strom Law Firm understand the complexity of qui tam and whistleblower suits, and we offer free, confidential consultations to discuss the facts of your case. Contact us today.803.252.4800



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