Topic: medicare fraud
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September 25, 2013 at 4:37 PM
FARGO, N.D. — A Seattle doctor accused of turning in phony Medicare claims that included nursing home visits to patients who were dead pleaded not guilty Wednesday in federal court.
John Chen pleaded not guilty to six counts, including health-care fraud and false statements related to health care. Trial is scheduled for Nov. 19 in Fargo.
The case is being tried in North Dakota because Fargo-based Noridian Healthcare Solutions LLC processes and pays Medicare Part B claims in Washington state.
Authorities said many of Chen’s claims for face-to-face appointments occurred when he was out of the country.
Chen, who appeared Wednesday via video from Seattle along with his lawyer, Robert Flennaugh II, faces a maximum penalty of 45 years in prison. Flennaugh did not respond to requests for an interview.
U.S. Attorney Timothy Purdon declined comment because the case has not been decided.
Authorities said Chen submitted 673 claims for medical services in the Seattle-Tacoma area from 2007 through 2010, when he allegedly was out of the country. He is accused of turning in 212 claims between April 2007 and July 2012 for nursing home visits that never took place.
The indictment said Chen failed to keep accurate notes of patient records for services billed to Medicare and also submitted his own claims to the federal program.
The government is asking Chen to pay back any losses and forfeit all property and proceeds that were gained as a result of the scheme.
U.S. Magistrate Judge Karen Klein ordered to Chen to remain on supervised release with conditions, including restriction of travel only to North Dakota. Chen had earlier surrendered his U.S. and China passports.
July 3, 2013 at 11:09 AM
A Tacoma firm that provides billing for physicians and other medical professionals in Washington and elsewhere has agreed to pay $14.5 million to settle allegations by a whistleblower that it overbilled Medicare and other federal health-care programs.
Sound Inpatient Physicians Inc. employs more than 700 clinicians and doctors to 70 hospitals and a growing number of post-acute care facilities in 22 states. A 2009 lawsuit, filed by a former employee, alleges the company routinely submitted claims that upgraded billing for its doctors.
The settlement, announced Wednesday, addresses allegations by a former employee that between 2004 and 2012, Sound Physicians submitted inflated claims on behalf of its doctors for higher and more expensive levels of service than were documented by in patient medical records.
“Fraudulently inflated billing of government health-care programs puts those programs at risk, and impacts the system’s ability to care for the neediest in our communities,” U.S. Attorney Jenny Durkan said in a statement. “During this time of tight government budgets, we will do all we can to make sure everyone plays by the rules and does not run up the taxpayers’ tab.”
Allegations that Sound Physicians had improperly billed a variety of federal health-care programs were brought to the government’s attention through a so-called “qui tam” lawsuit filed by a former Sound Physicians employee, Craig Thomas, under the whistleblower provisions of the False Claims Act.
The act allows private citizens to bring civil actions on behalf of the government and share in any recovery. Thomas will receive $2.7 million of the $14.5 million settlement for exposing Sound Physicians’ inflated claims.
About The Today File
The Today File is a general news blog featuring real-time coverage of Seattle and the Northwest. It is reported by the news staff of The Seattle Times and edited by Assistant Metro Editor Nick Provenza.
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