Articles Tagged with medically unnecessary

IMG_0368-300x200Frederick Gooding, a physician of Wilmington, Delaware, was charged in an indictment with 11 counts of health care fraud following an investigation into his participation in a $12.7 million scheme that sought to defraud Medicare.

According to the Department of Justice, Gooding submitted claims to Medicare for injections and aspirations that had either never been received or had no necessary medical purpose. Gooding continued this scheme from January 2015 to August 2018, stealing a total of $12.7 million during that time. To cover-up the health care fraud scheme, Gooding allegedly falsified numerous medical documents to show that the prescriptions and services he billed Medicare for were medically necessary.

Gooding was arrested for these allegations on August 1st, 2019, and the indictment was announced on August 2nd, 2019 by Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Jessie K. Liu of the District of Columbia, Acting Assistant Director in Charge John P. Selleck of the FBI’s Washington Field Office, Special Agent in Charge Maureen Dixon of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Philadelphia Regional Office and District of Columbia’s Inspector General Daniel W. Lucas.

Medicare-fraud-300x200Rossana Ramirez, a once certified nursing assistant, was discovered to be helping run a business in West Miami-Dade that is responsible for $7 million in health care fraud. After pleading guilty Ramirez was stripped of her license permanently through an Emergency Suspension Order and is now serving time at a federal detention center with a release date of June 2022.

Rossana Ramirez was registered in the state corporation registration as the vice president of a company titled F&E Home Health Care. While Rossana Ramirez is currently taking the heat from the Florida Department of Health, her husband Evelio Ramirez Jr. is also involved as the president of F&E. He will soon be starting his sentence of three years and ten months in federal prison himself. Both husband and wife are 59 and will both serve their time. Their pleas of guiltily were fairly straightforward and show that this act of fraud is not very uncommon from what has already been seen from healthcare fraud schemes in South Florida.

F&E is accused of paying kickbacks, a form of negotiated bribery in which a commission of sorts is given in return for services rendered, to those who receive Medicare and Medicaid to become F&E patients. Additionally, some of these patients did not even require home healthcare and the services promised were not often necessary or even provided at times. F&E is also accused of paying recruiters of Medicare and Medicaid recipients to promote their health services for them.