Medicare Fraud Strike Force Uncovers $2.6 Million Medicare Fraud Scheme by DME Owner

oamaru-white-stone-1-819458-m.jpgThe Medicare Strike Force of the FBI and HHS-OIG continues efforts to eliminate fraudulent healthcare providers from the healthcare arena. The Strike Force recently obtained a guilty plea by the former owner of a California durable medical equipment supply company (DME) business based on an alleged scheme to defraud Medicare of millions. Akinola Afolabi, 54, of Long Beach, California, pled guilty to one count of healthcare fraud and now faces up to 10 years in prison and a $250,000 fine. Afolabi’s sentencing by the U.S. District Court in the Central District of California will take place on November 25, 2013.

According to the government’s allegations in that case, Afolabi owned Emanuel Medical Supply Company. Emanuel was a DME supply company that sold, among other things, power wheelchairs and related supplies. The federal government alleged that Afolabi used Emanuel to provide medically unnecessary power wheelchairs and other DME to Medicare beneficiaries in California, during a three year period. Afolabi is alleged to have used “marketers,” among other means, to obtain Medicare beneficiaries’ contact information, which Afolabi submitted to the government to make false Medicare claims. Afolabi paid the marketers to refer Medicare beneficiaries to Emanuel. Afolabi then falsely certified to Medicare that each claim submitted was for medically necessary DME that was actually provided to the beneficiary, according to the government. During the subject time frame, Afolabi submitted to Medicare approximately $2.6 million in alleged fraudulent claims for the wheelchairs and related services, and Medicare paid out almost $1.5 million.

The Medicare Strike Force continues to combat healthcare fraud. Eliminating healthcare fraud and obtaining recoveries from bad actors remain a major push for the federal government as a means of reducing the cost of healthcare for our Country. Since 2007, the Strike Force has charged over 1,500 defendants who have together submitted more than $5 billion in Medicare claims.

Our Country’s strong dependence on a third party payer system and a common mindset that everyone should have health “insurance” or “free” healthcare, though perhaps good and noble in many ways, perpetuate financial motives and needs of third party payers which influence how and what healthcare is delivered. In the case of the federal government as a payer, the result is a very heavy burden for the financial tax payer and excessive regulation of healthcare businesses, which, though borne with good intentions (like preventing fraud by bad actors), may ultimately decrease patient access to quality healthcare.

In any event, all healthcare providers that participate in Medicare should be vigilant in ensuring that their business protocol and compliance programs tightly follow the law, include excellent documentation to support all Medicare claims, and are periodically reviewed and audited by professional compliance experts. Where Medicare or other government programs are concerned, great care and caution should be used.

Our law firm is a boutique business and healthcare law firm that represents healthcare providers and professionals with regard to Medicare compliance and fraud issues. We are focused on protecting health care professionals, helping them succeed in the business of healthcare, and enabling them to sleep better. Contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta) to schedule a confidential consultation.

Source: Indictment

*Disclaimer: Thoughts shared here do not constitute legal advice.

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