The big business of health care provider fraud

As you can see from reading this blog, we take all types of fraud seriously and fraud committed by health care providers is no different.

In fact, in 1994 we created the Health Care Provider Team (HCPT) to exclusively investigate this type of fraud.

This past fiscal year HCPT closed 64 cases, identified $19M in savings, made 11 criminal prosecution referrals, and obtained 3 convictions.

Just to give you an idea of the types of fraud committed by health care providers, here are a few of our most notable, recent cases.

Lawanna Porter, of Shaker Heights, who operated Palladium Healthcare, a home healthcare agency with more than 100 employees, failed to report having employees to various state agencies or to secure workers’ compensation, and failed to report her payroll to BWC. SID conducted this joint investigation with the Ohio Attorney General’s Office, Medicaid Fraud Control Unit. In addition to restitution, Porter was ordered to pay BWC $15,000 in investigative costs, for a total of $139,573. She was also sentenced to five years of community control. If she violates the terms of her sentencing, Porter could be sent to prison for 11.5 years.

Nelsonville chiropractor Michael L. Brown, D.C., whose patients were not at his office on days that he billed BWC for treating them, including dates his office was closed, and who fabricated the amount of treatment he provided to patients to receive a higher payment for services. Brown was ordered to pay $394,021 in restitution, which includes approximately $60,000 in investigative costs. He was sentenced to five years of probation. If he fails to comply with the terms of his probation, Brown could be sentenced to serve nine months in jail. Brown voluntarily decertified himself as a BWC health care provider.

Jeffrey Stychno, D.C., an Ohio chiropractor was sentenced to pay $89,000 in combined restitution to Medicaid and the Bureau of Workers’ Compensation (BWC). Stychno was ordered to pay $69,781 to BWC and $19,715 to Medicaid after he was convicted of fraudulent billing practices during his time as co-owner of Integrated Health in Warren, Ohio.

Joseph J. Yurigan, D.C., a chiropractor who formerly practiced in Weirton and Wheeling West Virginia was sentenced for health care fraud and tax evasion. Our investigation revealed Yurigan was routinely and consistently billing for services that he never provided to undercover operatives. The Federal Bureau of Investigations, the West Virginia Department of Insurance Commission, United States Treasury Department and the United States Attorney’s Office became involved in the investigation and executed a search warrant. Yurigan pleaded guilty and yesterday was ordered to make restitution totaling $836,066.

After reading these cases you have most likely come to the same conclusion…this big business is just not worth it!

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