Miami doctor convicted in $23 million Medicare fraud scheme
Compliance Monitor, April 20, 2011
Want to receive articles like this one in your inbox? Subscribe to Compliance Monitor!
A jury convicted Miami physician Rene De Los Rios of five felony counts for his role in a $23 million HIV injection and infusion Medicare fraud scheme, according to a Department of Justice (DOJ) press release.
According to the DOJ, Damaris Oliva, owner and operator of Metro Med of Hialeah Corp, hired De Los Rios to order unnecessary tests, sign medical analysis and diagnosis forms, and authorize treatments to make it appear that Metro Med provided legitimate medical services to Medicare beneficiaries. De Los Rios also diagnosed almost all of the patients at Metro Med with the same rare blood disorders, which the patients did not have, to ensure maximum reimbursement from Medicare.
According to the DOJ, Oliva paid the De Los Rios $3,000 per week for his involvement in the scheme.
De Los Rios faces a maximum of 10 years in prison and a $250,000 for the conspiracy charge. He could receive up to an addition five years for each false claims count.
Want to receive articles like this one in your inbox? Subscribe to Compliance Monitor!
Related Products
-
Billing Alert for Long-Term Care
It's essential to know how to correctly submit your Medicare claims in order to get the reimbursement your facility...
-
Core Skills for Hospital Case Managers:
A guide to fundamental case management responsibilities, Core Skills for Hospital Case Managers serves as a training...
-
The Compliance Officer's Handbook, 2nd Edition
This revised edition is packed with even more practical tools, case studies, tips and tools, sample audits, and sample...
-
2010 Observation Services Track:
On-demand audio recordings of the Observation Services track of HCPro Revenue Cycle Institute's popular Medicare Compliance...
-
Stark Law, 2nd edition: A user's guide to achieving compliance
This updated version of HCPro's Stark Law best seller, first published in 2005—and now co-authored by former CMS Stark...
Most Popular
- Articles
-
- Q/A: Volume requirement for reporting hydration services
- Featured blog post: Nurses face felony charges after reporting physician to the Texas Medical Board
- HIPAA Q&A: Level of encryption needed for email
- Catch up on what's new with injections and infusions
- Identify potential Medicaid RAC target areas
- Capturing all necessary codes for IUD insertion and removal can be challenging
- Topic: CMS, OESS post new security compliance review information, checklist
- What does case-mix index mean to you?
- OB services: Coding inside and outside of the package
- Q/A: Coding infusions to correct low potassium levels
- E-mailed
-
- Q/A: Volume requirement for reporting hydration services
- Featured blog post: Nurses face felony charges after reporting physician to the Texas Medical Board
- HIPAA Q&A: Level of encryption needed for email
- CMS has reformulated payments for some bilateral procedures
- Q&A: Follow CMS' coding guidelines when using modifier -25
- Understand the spine to code back procedures correctly
- What does case-mix index mean to you?
- Catch up on what's new with injections and infusions
- New conflicts of interest create new challenges
- Q/A. One injection code or two?
- Searched