The Department of Justice (DOJ) and Federal Bureau of Investigation (FBI) announced that the CEO of Mobile Doctors USA LLC was arrested and charged with health care fraud and one physician associated with Mobile Doctors was arrested and charged with making false statements related to health care benefits. Additionally, search warrants were executed at Mobile Doctors’ offices in Chicago, Detroit and Indianapolis and seizure warrants were executed to seize up to $2.568 million in alleged fraud proceeds from various bank accounts. This investigation is a result of the Medicare Fraud Strike Force operating in Chicago since February 2011, which is part of the Health Care Fraud Prevention and Enforcement Action Team (HEAT).
Mobile Doctors manages physicians who make house calls in six states. The physicians assign their rights to bill and collect payment to Mobile Doctors, and are paid directly by the company. The government alleges that Mobile Doctors upcoded bills for in-home patient visits; falsely claimed that these in-home visits were more complicated and/or longer in length than a standard visit; and falsely certified that patients were confined to their homes, which enabled home health care agencies to claim fees for additional patient services. The government alleges that claims data from 2006 through February 2013 shows that approximately 99 percent of all established-patient visits by Mobile Doctors physicians were billed to Medicare using the two highest billing codes available for the visits.
The health care fraud count against the CEO carries a maximum penalty of 10 years in prison and a $250,000 fine. Restitution is mandatory. The false statements count against the physician carries a maximum of five years in prison and a $250,000 fine.
This HEAT investigation is significant for both individuals and entities that outsource billing and collection services, as well as those companies that provide such services, and receive reimbursement under federal health care programs. Policies, procedures and training must be provided to all relevant employees and contractors related to appropriate billing practices. Monitoring and auditing programs also are critical.