Friday January 11, 2013
Please share this Fraud Alert with colleagues, consumers, or other professionals in your area. If you have any questions about the Illinois SMP program, or to receive these Fraud Alerts directly, please contact Jason Echols, Healthcare Consumer Protection Coordinator at AgeOptions.
This project was supported in part by grant numbers 90MP0163 and 90SP0015 from the U.S. Administration on Aging, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.
Fraud In The News
The following are current news articles about health care and fraud issues.
Health Care Fraud:
- “Caught in the dragnet: Feds clamp down on Medicare abuse” (Crain’s Chicago Business):
- “Sheriff Warns of Lottery Scam” (Cook County Sherriff’s Department)
- “Attorney General Madigan, ICC Warn Utility Customers of Scam Artists Posing as Utility Company Reps, Demanding Payment” (IL Attorney General’s Office):
Dear SMP readers,
This week’s Fraud Alert containsa scam warning from the Springfield Police Department (attached to this email), three stories about sentencing in health care fraud cases, and a report on the first year of Medicare’s Fraud Prevention System.
Have a great weekend!
What you will find in this week’s Fraud Alert
- Springfield Police Ask for Help in Finding Scammer
- Palos Hills Home Health Owner Sentenced to 10 Years for Fraud
- Illinois Physician Sentenced After 13 Years as Fugitive
- Southern Illinois Dentist Sentenced in Medicaid Fraud Case
- CMS Fraud Prevention System Saved Money In Its First Year
The Springfield Police Department recently issued an alert for a man who is calling older adults pretending to work at their bank as part of a scam.The scammer says that another bank employee may be stealing money from their account and that he needs their help to catch the thief. He then convinces the older person to withdraw cash and give it to him. The Springfield Police are asking for help in catching this criminal. For the full details, please read the release attached to this email.
If someone calls you claiming to be from your bank or any institution you do business with, you can verify who they are by hanging up and calling that business using a number you already have. Remember your bank does not call to verify your personal information or to ask you for cash.
Palos Hills Home Health Owner Sentenced to 10 Years for Fraud
A federal judge has sentenced Bahir Haj Khalil, co-owner of House Call Physicians in Palos Hills, IL, to 10 years in prison for his role in a Medicare fraud scheme.According to a press release from the U.S. Department of Justice (DOJ), the judge also ordered Khali to pay restitution and forfeiture, both in the amount of $2,934,392. Court records state that Khali provided medically unnecessary services and directed the certification of patients for home health when they were not homebound, which is a Medicare requirement for receipt of home health services. Two other defendants were sentenced in regards to this scheme. Read the full DOJ press release here:
Illinois Physician Sentenced After 13 Years as Fugitive
The Federal Bureau of Investigation (FBI) announced that Juan Rios, who practiced as a physician in Southern Illinois in the mid to late 1990s, was recently sentenced to 37 months in prison and ordered to pay fines and restitution totaling over $320,000 partly for his role in a health care fraud scheme. After his first indictment in December 1999, Rios fled the country; he was captured 13 years later. Read more in this FBI press release:
Southern Illinois Dentist Sentenced in Medicaid Fraud Case
A dentist in Wayne County was sentenced for defrauding the Illinois Medicaid program. Walter Dawkins was sentenced to serve one year imprisonmentfollowed by three years’ supervised release, a $900 fine, and restitution to the Illinois Medicaid program in the amount of $1,242.68. He was charged with illegally writing prescriptions for hydrocodone and billing Medicaid. Read the full press release here:
CMS Fraud Prevention System Saved Money In Its First Year
The Centers for Medicare and Medicaid Services (CMS)reported to Congress on the first year of its Fraud Prevention System (FPS). FPS uses predictive analytics technology to stop improper payments on claims before payment is made instead of paying a claim and then trying to reclaim improper payments later. According to this report, FPS saved Medicare $3 for every $1 spent, prevented or identified an estimated $115.4 million in payments, and generated leads for 536 new investigations. Read the full report here:
Jason B. Echols, MSW, Health Care Consumer Protection Coordinator
AgeOptions
1048 Lake Street, Suite 300
Oak Park, IL60301
phone (708)383-0258 fax (708)524-0870
ageoptions.org
AgeOptions, the Area Agency on Aging of Suburban Cook County, is committed to improving the quality of life and maintaining the dignity of older adults and those who care about them – through leadership and support, community partnerships, comprehensive services, accurate information and powerful advocacy.
Fraud Alertscontain information about current scams taking place in Illinois, announcements and updates about programs or services related to health care and/or fraud protection, and links to news articles about health care and fraud topics. Please forward any recommendations or announcements that you would like to be included in a future Fraud Alert to .