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Fraud Week: More Non-Existent Services


If our most recent Fraud Week post (NY Chiropractor Billed for Non-Existent Acupuncture Services) didn’t already drive home the point, it is worth emphasizing that billing insurers for items or services that weren’t actually provided is always a bad idea.

On August 4, the U.S. Department of Justice (DOJ) announced that Ariel Madero Paez, the owner of Always Medical Supply, pleaded guilty to fraudulently billing Medicare for durable medical equipment (DME) that was never provided to beneficiaries. The individuals never even requested the DME. The Stuart, Florida-based company billed Medicare about $2.2 million and was paid over $1.4 million.

On August 8, DOJ announced that Jaroslava Ruiz of Chapel Hill, North Carolina was convicted of nine counts of healthcare fraud and one count of conspiracy to commit healthcare fraud and wire fraud for her role in a scheme in which over $34 million in false claims were submitted to private insurers. Ruiz paid bribes and kickbacks to patient recruiters and patients with private insurance so that they would permit four Miami physical therapy clinics to bill for services that were never actually provided to those patients. The insurers paid Ruiz’s co-conspirators almost $8 million.

Finally (for today), DOJ announced on August 9 that Sherley L. Beaufils, a Georgia nurse practitioner, was sentenced to more than seven years in jail and ordered to pay more than $1.6 million in restitution for her role in a fraud scheme. Beaufils falsely claimed to have provided medical exams on patients she never met, and then created orders for about 3,000 orthotic braces that resulted in more than $3 million in fraudulent or excessive charges to Medicare. The patients’ identities were obtained by Beaufils’ co-conspirators through a telemarketing scheme.

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