General Surgery Coding Alert - 2015 Issue 28
Physician Notes: Physician Kickbacks Lead to Jail Time
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Article Overview
This article summarizes multiple Department of Justice and newspaper-reported enforcement actions involving home care and hospice fraud. It focuses on allegations and convictions tied to kickbacks, falsified records, money laundering, tax issues, and Medicare-related misconduct. The piece is relevant to compliance teams, coders working with home health and hospice claims, auditors, and healthcare administrators who track fraud trends and enforcement activity.
Why This Topic Matters
It highlights how fraud and abuse investigations in home health and hospice can lead to criminal penalties, restitution, and exclusion-related risk. Readers can use it to understand the kinds of compliance issues drawing federal scrutiny in Medicare-related care settings.
Article Sections
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Federal enforcement overview
Introduces the broader pattern of fraud enforcement in home care and hospice settings and frames the article as a roundup of recent cases.
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Detroit case: home care fraud and kickbacks
Summarizes a Medicare fraud prosecution involving patient recruitment, referrals, record falsification, and related investigative actions.
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Detroit case: billing, fake patient files, and laundering
Covers a separate Detroit home health agency matter involving billing concerns, fabricated records, and financial misconduct.
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Pennsylvania hospice medical director sentencing
Describes a hospice-related sentencing following false certification allegations and references the defendant’s other criminal sentence.
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Oklahoma hospice owner sentencing
Reviews a hospice fraud case involving concealment of patient condition and documentation issues connected to a Medicare audit.
What You Will Learn
- How federal enforcement actions are being used in home care and hospice fraud cases
- What kinds of compliance failures can trigger criminal investigations in Medicare-related settings
- The general categories of misconduct described in recent hospice and home health prosecutions
- How documentation and billing issues can become part of broader fraud cases
Who Should Read This
- Medical coders
- Compliance officers
- Healthcare auditors
- Home health administrators
- Hospice administrators
- Revenue cycle teams
- Healthcare attorneys
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