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Your Daily Posterous Spaces Update September 29th, 2011 Hill-Rom

settles Medicare fraud lawsuit -

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Hill-Rom settles Medicare fraud lawsuit

BATESVILLE, Ind.

Hill-Rom Holdings Inc., a medical-equipment company in Indiana, agreed

Tuesday to pay nearly $42 million to settle a government lawsuit that

alleged Medicare fraud.

The government had accused the company of knowingly submitting false claims

to Medicare from 1999 to 2007 for bed support surfaces meant to treat

pressure ulcers and bedsores. According to the charges, Hill-Rom asked

" numerous and repeated " times for payment from Medicare for patients who no

longer qualified for it, including patients who had died or were no longer

using the equipment.

According to the charges, Hill-Rom would automatically bill Medicare for

" long periods of time, " " without making any reasonable effort to determine

if the patients for whom it submitted the claims continued to meet Medicare

conditions for payment. "

Hill-Rom denied wrongdoing.

" Hill-Rom is dedicated to the highest standards of business conduct and

integrity, " the company said in a statement. " We vigorously disagree that

there was any wrongdoing in this situation and this settlement does not

represent any admission on our part. "

Shares rose 3.6 percent to $31.29, as investors reacted favorably to the

certainty the settlement provides.

Still, shares haven't recovered from the fall they took July 28, when they

fell to $36.25 from $43.88. That was the day after the company said in its

third-quarter earnings report that it was close to a settlement on the

federal charges. It also announced then that it had set aside money to pay

for the settlement.

The U.S. Attorney's Office for the Eastern District of Tennessee said the

$41.8 million settlement is its largest civil fraud recovery ever. More than

$8 million will go to two whistleblowers who helped with the government's

investigation, nurses who worked as sales representatives for Hill-Rom.

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Nursing-home director faces kickback charge - Lincolnshire

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Nursing-home director faces kickback charge

September 27, 2011 11:30AM

The director of admissions at The Wealshire, a nursing home in Lincolnshire,

has been charged with accepting a $1,600 kickback in exchange for referring

nursing home Medicare patients to a home health care agency in West Dundee.

Jay Canastra, 38, of Vernon Hills, was charged with one count of violating

the anti-kickback statute in a criminal information filed in U.S. District

Court.

According to the charge, on Dec. 4, 2009, Canastra received a $1,600 cash

kickback from unnamed Individual A, who was a representative of unnamed

Agency A, which was authorized by Medicare to provide home heath services.

Canastra allegedly accepted the payment in exchange for referring Medicare

beneficiaries at his nursing home to Agency A, in violation of the federal

law that makes it illegal to exchange kickbacks in return for Medicare

referrals. There is no allegation that the nursing home or any other

official there was aware of the alleged kickback.

The case is part of a nationwide take-down by the Medicare Fraud Strike

Force, the U.S. departments of Justice, and Health and Human Services. The

total investigation led to charges against 91 defendants for schemes to

collectively submit more than $295 million in fraudulent claims to Medicare.

The defendants were charged with various crimes, including health care fraud

for allegedly defrauding the Medicare program, and violating the

anti-kickback statute, which makes it illegal to offer or solicit kickbacks

for referrals of Medicare patients.

The charges involve various medical treatments and services, including

surgery, nursing home care, chiropractic and psychotherapy services.

Others in the Chicago cases are:

Dr. , a vascular surgeon who had privileges at Northwest

Community Hospital in Arlington Heights. Natale, 62, of South Barrington,

was charged with two counts of health care fraud, two counts of making false

statements involving a health care benefit program and one count of mail

fraud.

Keennan R. Ferrell, a licensed psychologist in Illinois and at least a

half-dozen other states, and Bryce Woods, who was not in a medical

profession and owned and operated Take Action and Innert Arts, which claimed

to provide psychotherapy services to Medicare beneficiaries residing in

skilled nursing homes. Ferrell, 51, and Woods, 34, both of Chicago, were

charged with nine counts each of health care fraud.

Three chiropractors, Bradley Mattson, and Neelesh Patel, who own

suburban clinics that provided chiropractic, medical and physical therapy

services, were charged in a 23-count indictment with defrauding three

private health insurance companies for more than a decade, beginning in

1999.

Mattson, 49, of Lake Forest, was charged with 19 counts of health care

fraud; , 40, of Northbrook, was charged with four counts of health care

fraud; and Patel, 36, of Glenview, was charged with 15 counts of health care

fraud.

The government is represented by Assistant U.S. Attorney Dylan . The

case was investigated by the FBI and the HHS-OIG.

The charges in these cases carry the following maximum penalties on each

count: health care fraud — 10 years in prison, mail fraud — 20 years in

prison, and both carry a $250,000 maximum fine, or an alternate fine

totaling twice the loss or twice the gain, whichever is greater; and making

false statements regarding a health care matter, and violating the

anti-kickback statute — five years in prison and a $250,000 fine. If

convicted, the U.S. Court must impose a “reasonable sentence” under the

advisory U.S. Sentencing Guidelines.

Medicare Fraud Strike Force operations, which expanded to Chicago in

February, are part of the Health Care Fraud Prevention & Enforcement Action

Team, a joint initiative announced in 2009 between the Department of Justice

and HHS to focus their efforts to prevent and deter fraud and enforce

current anti-fraud laws around the country. Since their inception in March

2007, Strike Force operations in nine locations have charged more than 1,140

defendants who collectively have falsely billed the Medicare program for

more than $2.9 billion. In addition, the HHS Centers for Medicare and

Medicaid Services, working in conjunction with the HHS-OIG, is taking steps

to increase accountability and decrease the presence of fraudulent

providers.

The results of the nationwide take-down were announced by Attorney General

Holder, HHS Secretary Kathleen Sebelius, FBI Director S. Mueller,

Assistant Attorney General Lanny A. Breuer of the Criminal Division and

Inspector General R. Levinson of the HHS-OIG. Fitzgerald

announced the Chicago charges together with D. Grant, special

agent-in-charge of the Chicago office of the Federal Bureau of

Investigation; Lamont Pugh III, special agent-in-charge of the Chicago

Regional Office of the HHS-OIG, Vanderberg, special agent-in-charge of

the Labor Department Office of Inspector General in Chicago; and P.

Brady, inspector-in-charge of the Chicago office of the U.S. Postal

Inspection Service.

The public is reminded that indictments and informations contain only

charges and are not evidence of guilt. The defendants are presumed innocent

and are entitled to a fair trial at which the government has the burden of

proving guilt beyond a reasonable doubt.

To learn about the Health Care Fraud Prevention and Enforcement Action Team,

go to www.stopmedicarefraud.gov.

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