Read Case Study #1 (Page 151) Review and analyze the facts in the OIG press rele

Question

Read Case Study #1 (Page 151)

Review and analyze the facts in the OIG press release shown in Box 8-4.

Discuss what you would do had you been the administrator of this hospice and these five nurses worked for you. If you discovered this fraud prior to the government audit, how would you handle this situation internally? Be specific about what actions you would take. What might you do to prevent future staff members from perpetrating this same type of fraud at your facility?

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CHAPTER COMPLIANCE PLANs 151 WHEN YO THE ADMINISTRATOR tical Thinking and Analysis Case Study Hospice Employe, Fr, d Revicw and de facts in the OIG press release shown is4 Discuss what you would do had you the administrator of this hospice and these s worked for you. If you discovered this fraud prior to the government audit, how would you handle this situation int ernally? Be specific about what actions you would take. What might fee nurses worked for you. If you discovereds this trating this same type of fraud at your facility? you do to prevent future stfnembers from perpe- trating this same type of fraud at your facility? Multi-Million Dollar Hospice Health Care Fraud Scheme Aleged PHILADEUPHA-A spirscy arising from ther employtment at Home Cae in Phladelghu, between 2005 and 2008, thar resuited in a multimlion dolr faud on An indictment was urseaied today charging tue nuses n a heath care tad con- McGI 64, of Philadelphia, was a registered nurse and served as the Drecor of Proessiona chargrd, along with Natalya Shvets, 42, of Ssouthhampton PA Gerg Orphd,6, ofPiladephi count of conspiracy to commit ealith care troud and nunmerss ounts of heath cre taua Aive Oeendons wwere arrested ths moming HCH was coomed by Matthew Kolodesh, who scraped Stpuratry n rdonnent unsealed October 12, 2011, and "AP-the Hopee Diecto, for HCH HCH wasforrot burea 1810 Grant Aerue·ar d later 2801 Grant Avenue-'n Ph ladelpha, that ponded hospce sence5 for patents at nusing homes horptas, and prvate residerces According to the ndcment announced by United Sanes Attorngy Zane David Mereger, McGil authoried rusing suff and supervinors, eokding her patents Detween Jssuary 2005 and Decemb 2008 appromanely 59.328.000 in traudulent Cams for inuppropriate patents were submitted to Medicare authorizid by AP and McGl Detendant shvets, Ogroshidre, Goltmun and Koptyaiov created fraudulent nursing notes for acproximabely 150 patents ndcating hospce serves were provided for patent· nuity hy were ot In February 2007, HCH was nofied that it was subject to a dams eview audt According to the indctment in antopation of ths audt McGil assted A./ in reviewing patent charts, sanctoning tase taff, and authoraing the alteration of charts In September 2007, HCHs M mpay $2.625047 documentation by thenaning noted that it, had eaceeed its cap for pledare reimbuement and wold ha changs holpice patonts This resuted in a mass dscharge of patents in one monts, 79hospice patents were discharged in Oetober 2007 and a total of 128 dohwrgedl by enary 2008some of whom had been ineigble for hospice or inappreprutey maintaned on hospice service in excess of sx monehs Sone of the pitents docharged were shälfted to snother hospice busiress owned by kolodoh is the Spring of2008, appronte y 20% of he docho ged patents were placed baci on ha pice erncert. CH with McGil's knowledge. McGilischarged in 14 counts Shvets s charged in eght counts Oppehidte is crged in seven counts Golman is charged in four counts, and Koptykov s charged in eight counts conwicted of all charges, McGill faces a potential advisory sentencing quideine range of 108 135 months in prson afne of up to 5150,000, and a$1400 special assessment Shuets Gotsmen, and Koptykov each face a poténtal advisory sencencing guideline rarge of 27 to 33 monts n grison a foe of up to 560,000, and an $800 special assement, Ogrohidze faces a potential adsary sendenong guideline range of 21 to 27 months in prisen a fino of up to 550,000 and 5700 special ament States The case was inestigated by the Federal Bureau of Ihwestigation and the Department of Healtch Crime and Gang Attarney Suzanne8 Ercole and Trial Attorney Margaret Verbuchen of the Orginind Section in the Justice Departments Crimns Division and Human Services Office of Inspector General It is being prosecuted by Assstant United Coned

Explanation / Answer

I would have taken necessary steps to terminate the five nurses who were behind this fraud.

I would have taken corrective action to recover the money.

Future fraud can be prevented by educating the patients and with strict supervision. Patients should be instructed to report suspected fraud to their State MFCU or SMA.

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