We have seen many Medicare fraud scams – phony providers who commit identity theft and bill for services never performed, surgeons performing unnecessary procedures, providers overbilling and “patient recruiters” paying homeless people to seek treatment they don’t need. Another scheme is phantom office visits.
In February, a New Jersey physician, Albert Ades MD, was indicted for Medicare fraud after prosecutors say he billed for phantom office visits; visits that never happened.
According to the indictment, between 2005 and June of last year, Dr. Ades billed Medicare, Medicaid and private insurance plans for office visits even though he never saw the patients on those dates.
Prosecutors claim that Ades instructed employees to alter patient charts to make it appear the patient was in the office. Ades was caught after an insurance company audited his records. A patient alerted the company after noticing that a prescription refill phone call was billed as an office visit. Prosecutors say that instead of admitting the mistake, Ades began destroying and altering records.
Ultimately, four employees cooperated with the FBI. One worker purportedly recorded a conversation in which Ades was confronted about his illegal activities. When asked about charging for office visits even though he never saw the patient, Ades said, “I wrote something — the fact that I wrote something, documented something – somebody’s paying me for that.”
via Phantom Office Visits and Medicare Fraud | The National Law Review.